RESEARCH ARTICLE


Effect of Dexmedetomidine on Postoperative Hemodynamics and Outcome of Free Flaps in Head and Neck Reconstructive Surgeries



Sunil Rajan*, Sumana Moorthy, Jerry Paul, Lakshmi Kumar
Department of Anaesthesia, Amrita Institute of Medical Sciences, Amrita Vishwavidya Peetham, Kochi, Kerala, India


Article Metrics

CrossRef Citations:
2
Total Statistics:

Full-Text HTML Views: 4341
Abstract HTML Views: 2678
PDF Downloads: 1130
ePub Downloads: 639
Total Views/Downloads: 8788
Unique Statistics:

Full-Text HTML Views: 2097
Abstract HTML Views: 1288
PDF Downloads: 862
ePub Downloads: 469
Total Views/Downloads: 4716



Creative Commons License
© Rajan et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India; Email: sunilrajan@aims.amrita.edu


Abstract

Background and Aims:

Dexmedetomidine is less frequently used during free flap surgeries for fear of causing vasoconstriction leading to flap failure as it is an α2 agonist. But most patients following major resections with free flap reconstruction develop uncontrolled hypertension postoperatively which could lead to complications resulting in reduced flap perfusion. We aimed to compare the effects of dexmedetomidine on postop haemodynamics, re-exploration rates and final outcome of free flaps in patients who underwent reconstructive surgeries.

Material and Methods:

This prospective, randomized study was conducted in 40 patients aged 20-70 years. Patients in both groups received morphine 0.1mg/kg, 30 minutes before end of surgery. In addition, in Group D dexmedetomidine 1mcg/kg bolus was also given at the same time, followed by 0.5mcg/kg/hr infusion. Post operatively the patients received either dexmedetomidine 0.5mcg/kg/h (Group D) or morphine 2mg/hr (Group M) infusion for 12 hours.

Statistical analysis was done using Chi-Square test and independent sample t test.

Results:

Morphine group had significantly higher heart rate (105.2 ± 7.5 vs 90.0 ± 11.7), systolic blood pressure (167.5 ± 7.3 vs 125.4 ±16.6) and mean arterial pressures (103.5 ± 4.6 vs 87.8 ± 12.2) than dexmedetomidine group. Same trend persisted till 12 hours post operatively. More patients in morphine group required re-exploration of the flap (15 vs 10%) and had flap failure (7.5 vs 2.5%), but these differences were not statistically significant.

Conclusion:

Dexmedetomidine can be safely used in patients with free flap reconstruction as it optimizes postoperative hemodynamics and is not associated with any significant increase in re-exploration or flap failures.

Key Messages:

Dexmedetomidine resulted in optimal postoperative hemodynamics, reduced re-exploration rate and better flap outcome.

Keywords: Dexmedetomidine, Free flap surgery, Nontuberculous, Vasoconstriction.