title: Safety of vasopressor use in head and neck microvascular reconstruction: a prospective observational study.
abstract: OBJECTIVE
  To evaluate the safety of intraoperative vasopressor administration in a prospective series of patients undergoing free tissue transfer surgery for a variety of indications.
  
  
  METHODS
  Prospective observational noninferiority study.
  
  
  METHODS
  Tertiary academic hospital.
  
  
  METHODS
  A total of 169 consecutive patients undergoing free tissue transfer for a variety of indications between late 2007 and 2009.
  
  
  METHODS
  Intraoperative vasopressor use and surgical outcomes data were prospectively collected. This study was designed to test the noninferiority of intraoperative vasopressor exposure versus no intraoperative vasopressor use on early flap failure.
  
  
  RESULTS
  A total of 169 free flaps were performed during the study period. Six early free flap failures occurred overall. The proportion of patients experiencing early flap failure was 4.4% (4/90) in those exposed to intraoperative vasopressors versus 2.5% (2/79) in those not exposed, with an absolute difference of 1.9 percentage points (90% confidence interval, -1.4 to 5.2). Thirty-eight percent of patients in the vasopressor group experienced medical and/or surgical complications other than total flap loss versus 43% in the nonvasopressor group (odds ratio, 0.80; 95% confidence interval, 0.43-1.49).
  
  
  CONCLUSIONS
  Intraoperative vasopressor use may be more common than previously realized in free tissue transfer surgery. Intraoperative vasopressor use does not result in a significant absolute increase in the rate of flap deaths.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health-Sciences University, Portland, Oregon 97239, USA.
authors.forename: Marcus M
authors.initials: MM
authors.lastname: Monroe
authors.forename: Steven B
authors.initials: SB
authors.lastname: Cannady
authors.forename: Tamer A
authors.initials: TA
authors.lastname: Ghanem
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Swide
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
mesh_terms: D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival / Q000187:drug effects*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D055806:Microvessels / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents