Clinical Procedure
 
Aliases:
Free flap graft

Topic aliases are alternate phrasings for a particular topic.


Ask surgeon if arm will be used a donor site, and if so, place lines in opposite arm or legs if not being used.

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Consider a pre-induction arterial line if using remifentanil at induction to monitor for hypotension.

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A remifentanil infusion allows refined titration of analgesia & blood pressure. Surgeons may ask you to avoid vasopressors to optimise graft perfusion, which you may need if you use morphine/ fentanyl.

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If hypotension is a problem and the surgeons are keen to avoid the administration of vasopressors, consider whether increasing the heart rate ( in appropriate patients with already low heart rates ) with anticholinergic agents such as glycopyrrulate may increase the cardiac output sufficiently to normalise the blood pressure.

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Good review article on anaesthesia for free flaps from FRCA www.frca.co.uk/article.as...

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