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Effects of Vasopressor Administration on the Outcomes of Microsurgical Breast Reconstruction

Chen, Chen MS*; Nguyen, Minh-Doan MD, PhD*; Bar-Meir, Eran MD*; Hess, Philip A. MD; Lin, Samuel MD*; Tobias, Adam M. MD*; Upton, Joseph III MD*; Lee, Bernard T. MD*

doi: 10.1097/SAP.0b013e3181bda312
Hand Surgery and Microsurgery

The use of vasopressors during microsurgery is still debated. General anesthesia often induces hypotension, but microsurgeons are reluctant to use intraoperative vasopressors with the potential risks of vasoconstriction. A retrospective review was performed on 187 consecutive patients undergoing 258 deep inferior epigastric perforator flaps, free transverse rectus abdominis myocutaneous flap, and muscle-sparing free transverse rectus abdominis myocutaneous flap operations. A total of 102 patients (140 flaps) received intraoperative ephedrine and/or phenylephrine and 85 patients (118 flaps) did not. The administration of vasopressors did not affect the rates of reoperation, complete flap loss, partial flap loss, or fat necrosis. Patients receiving vasopressors had no differences in operative time, number of perforators, or number of rows of perforators harvested. There was no statistically significant association between dosage, timing, and complications. Although we do not recommend routine vasopressor use during microsurgery, administration does not seem to increase complications in microsurgical breast reconstruction.

From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Boston, MA; and †Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Received April 28, 2009 and accepted for publication, after revision, August 23, 2009.

Presented at the 54th Annual Meeting of the Plastic Surgery Research Council, Pittsburgh, PA, May 27–30, 2009.

None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this article.

Reprints: Bernard T. Lee, MD, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 5A, Boston, MA 02215. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.