title: Safety of intra-operative vasopressor in free jejunal flap reconstruction.
abstract: BACKGROUND
  Microvascular surgeons always hold strong belief against the use of vasopressors during free flap surgery. Our aim is to study the safety of intra-operative vasopressors on free jejunal flap reconstruction.
  
  
  METHODS
  A retrospective chart review was performed on patients undergoing free jejunal flap reconstruction, aiming at investigating the intra-operative use of vasopressors and the potential complications associated.
  
  
  RESULTS
  Between 1984 and 2012, 110 free jejunal flaps were performed for reconstruction of circumferential pharyngeal defects created after resection of cancers of the hypopharynx. Intra-operative vasopressor was given in 81 (73.6%) patients. The most common vasopressors used were ephedrine (42.7%), phenylephrine (14.5%) or both (42.8%). They were administered to the patients before the start of flap harvesting (n = 32, 29.1%), during the flap harvesting (n = 30, 27.3%), during microvascular anastomosis (n = 20, 18.2%), or they were given more than once during the whole operation (n = 28, 25.4%). The incidence of intra-operative re-anastomosis due to thrombosis was 4.5% and the post-operative flap failure rate was 5.4%. There was no significant relationship between the administration of vasopressor during surgery and the need for intra-operative re-anastomosis, post-operative flap failure and the timing of flap failure. Similarly, there was also no relationship between the timing of vasopressor administration and the above variables. The long-term stricture rate was 2.7%, the risk of which was not increased by the intra-operative use of vasopressors.
  
  
  CONCLUSIONS
  The intra-operative use of vasopressors is safe in free jejunal flap reconstruction.
authors.affiliation: Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China. chanjyw@gmail.com
authors.forename: Jimmy Yu Wai
authors.initials: JY
authors.lastname: Chan
authors.forename: Velda Ling Yu
authors.initials: VL
authors.lastname: Chow
authors.forename: Lawrence Hin Lun
authors.initials: LH
authors.lastname: Liu
mesh_terms: D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology; D007275:Injections, Intravenous; D007430:Intraoperative Care / Q000009:adverse effects / Q000379:methods; D007431:Intraoperative Complications / Q000188:drug therapy*; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents