Abstract
Reconstruction of skin, muscle and bone loss due to previous traumatic injuries or congenital defects by transferring free vascularized tissue (free flaps) has been made possible by recent and continuous improvements of microsurgical techniques and is the background on which hand transplant surgery stands. Surgical skill is a well-recognized factor of success in free flap surgery, but hypoperfusion and subsequent necrosis of transferred tissues are important problems [1] which challenge both surgeon and anaesthesiologist. Anaesthesia influences central haemodynamics and regional blood flow and therefore may affect blood flow in the flap [2] or in the transplanted limb. Changes in blood volume and use of vasoactive drugs during anaesthesia may influence free flap perfusion as well [3].
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References
Hidalgo DA, Jones CS (1990) The role of emergent exploration in free tissue transfer. A review of 150 consecutive cases. Plast Reconstr Surg 86:492–499
Sigurdsson GH, Banic A, Wheatley AM, Mettler D (1994) Effects of halothane and isoflurane anesthesia on microcirculatory blood flow in musculocutaneous flaps. Br J Anaesth 73:826–832
Banic A, Krejci V, Emi D et al (1999) Effects of sodium nitroprusside and phenylephrine on blood flow in free musculocutaneous flaps during general anesthesia. Anesthesiology 90:147–155
McDonald DJF (1985) Anesthesia for microvascular surgery: a physiological approach. Br J Anaesth 57:904–912
Fanelli G, Casati A, Garancini P, Torri G (1999) Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance and neurologic complications. Study Group on Regional Anesthesia. Anesth Analg 88(4):847–852
Ertug Z, Yegin A, Sahin N et al (2005) Comparison of two different techniques for brachial plexus block: infraclavicular versus axillary technique. Acta Anesthesiol Scand 49(7):1035–1039
Pham-Dang C, Kirck O, Collet T et al (2003) Continuous peripheral nerve blocks with stimulating catheters. Reg Anesth Pain Med 28(2):83–88
Kaufman RD, Walts LF (1982) Tourniquet induced hypertension. Br J Anaesth 54:333–337
Grassi G, Giannattasio C, Failla M et al (1995) Sympathetic modulation of radial artery compliance in congestive heart failure. Hypertension 26:348–354
Failla M, Grappiolo A, Emanuelli G et al (1999) Sympathetic tone restrains arterial distensibility of healthy and atherosclerotic subjects. J Hypertens 17:1117–1123
Oden B (1961) Microlymphangiographic studies of experimental skin autografts. Acta Chir Scand 121:219–232
Van Der Werff JF, Medici G, Hovius SER, Kusuma A (1995) Axillary plexus blockade in microvascular surgery, a steal phenomenon? Microsurgery 16:141–143
Sjogren S. Wright B (1972) Circulatory changes during continuous epidural blockade. Acta Anesth Scand 46[Suppl]:5–12
Cousins MJ, Wright CJ (1971) Graft, muscles and skin blood flow after epidural block in vascular surgical procedures. Surg Gynecol Obstet 133:59–65
Tuman KJ, McCarthy RJ, March RJ (1991) Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 73:696–704
Modig J, Malmberg P, Karlston G (1980) Effect of epidural versus general anesthesia on calf blood flow. Acta Anesth Scand 24:305–310
Modig J, Borg T Karlstom G et al (1983) Thromboembolism after hip replacement: role of epidural and general anesthesia. Anesth Analg 62:174–180
Patel SS, Goa KL (1996) Sevoflurane. A review of its pharmacodynamic and pharmacokinetic properties and its clinical use in general anesthesia. Drugs 51(4):658–700
Ebert TJ (1996) Cardiovascular and autonomic effects of sevoflurane. Acta Anesthesiol Belg 47(1):15–21
Dolan WM, Stevens WC, Eger El (1974) The cardiovascular and respiratory effects of isoflurane-nitrous oxide anesthesia. Can Anaesth Soc J 21:557–565
O’Sullivan H, Jennings F, Ward K (1981) Human bone marrow biochemical function and megaloblastic hematopoiesis after nitrous oxide anesthesia. Anesthesiology 55:645–650
Rothen HU, Spore B, Engberg G et al (1995) Influence of gas composition on recurrence of atelectasis after a reexpansion maneuver during general anesthesia. Anesthesiology 82:832–842
Tateislii J, Faber JE (1995) Inhibition of arteriole alpha-2 but not alpha-1 adrenoceptor constriction by acidosis and hypoxia in vitro. Am J Physiol 268:H2068–2076
Grubcr UF (1975) Dextran and the prevention of postoperative thrombo-embolic complications. Surg Clin N Am 55:679–685
Ring J, Messmer K (1977) Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet 1:466–470
Kakizoe E, Kobayashi Y, Shimoura K et al (1993) Spectrophotometric study of alpha-adrenoceptors affecting microcirculation of rat skin. Clin Exp Pharmacol Physiol 20:421–427
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Vitale, G., Martinez, E., Maisano, P., Saini, M., De Marchi, L., Bellani, G. (2007). Anaesthetic Management. In: Lanzetta, M., Dubernard, JM., Petruzzo, P. (eds) Hand Transplantation. Springer, Milano. https://doi.org/10.1007/978-88-470-0374-3_21
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DOI: https://doi.org/10.1007/978-88-470-0374-3_21
Publisher Name: Springer, Milano
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