Anestesia e retalhos microvascularizados

Cláudia Margarida Brito Pereira; Maria Eduarda Leite Figueiredo; Rita Carvalho; Dora Catre; José Pedro Assunção

doi:10.1590/S0034-70942012000400011

Review Article

Anestesia e retalhos microvascularizados

Anesthesia and surgical microvascular flaps

Cláudia Margarida Brito Pereira; Maria Eduarda Leite Figueiredo; Rita Carvalho; Dora Catre; José Pedro Assunção

http://dx.doi.org/10.1590/S0034-70942012000400011 Braz J Anesthesiol, vol.62, n4, p.571-579, 2012

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Resumo

JUSTIFICATIVA E OBJETIVOS: A cirurgia reconstrutiva de cabeça e pescoço representa um grande desafio perante a necessidade de se conseguir um bom resultado estético e funcional. A anestesia pode ser um fator importante e determinante no sucesso da técnica dado o seu papel na estabilidade hemodinâmica e no fluxo de sangue regional. Por outro lado, a anestesia regional, as variações no volume sanguíneo e o uso de fármacos vasoativos podem também influenciar o fluxo de sangue no retalho. Assim, devido à falta de recomendações baseadas em evidência, a técnica anestésica destes procedimentos é inspirada na maioria das vezes nas considerações patofisiológicas. O objetivo deste artigo é rever os aspectos relevantes no que diz respeito à prática anestésica destes casos. CONTEÚDO: Importância do tipo do retalho, considerações fisiológicas e abordagem anestésica. CONCLUSÕES: O papel do anestesiologista inclui para cirurgia com retalhos microvasculares a otimização das condições fisiológicas para a sobrevida do retalho sem aumentar a morbidade não cirúrgica.

Palavras-chave

ANESTESIA, CIRURGIA, Vascular, Retalhos Cirúrgicos

Abstract

BACKGROUND AND OBJECTIVES: Head and neck reconstructive surgery represents a major challenge facing the need to achieve a good cosmetic and functional outcome. Anesthesia may be an important and determining factor in the technique success due to its role in hemodynamic stability and regional blood flow. On the other hand, regional anesthesia, changes in blood volume, and vasoactive drugs may influence blood flow in the flap. Thus, due to the lack of recommendations based on evidence, the anesthetic technique of these procedures is most often inspired in pathophysiological considerations. The aim of this paper is to review relevant aspects regarding anesthetic practice in these cases. CONTENT: Importance of the type of surgical flap, physiological considerations, and anesthetic approach. CONCLUSIONS: In surgery with microvascular flaps, the anesthesiologist role includes optimizing the physiological conditions for the survival of the flap without increasing the non-surgical morbidity.

Keywords

Anesthesia, Surgical Flaps, Vascular Surgical Procedures

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Anestesia e retalhos microvascularizados

Anesthesia and surgical microvascular flaps

Cláudia Margarida Brito Pereira; Maria Eduarda Leite Figueiredo; Rita Carvalho; Dora Catre; José Pedro Assunção

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