The Intraoperative Hemodynamic Control through Functional Parameters in Free Flap Reconstruction in Head and Neck Surgery: our Initial Expertise

Background: The role of intravenous fluids during surgical procedures is debated. Actually, many studies show the utility of managing hemodynamic control in operating room through non-invasive or minimally invasive cardiac output monitoring. The intraoperative fluids administration could be guided by functional hemodynamic parameters to avoid hypervolemia during free flaps reconstruction in ENT surgery. Materials and Method: In our ENT department we have used both functional hemodynamic parameters through VIGILEO® monitoring (VIGILEO group) and anaesthesiological recommendations (STANDARD group) during major ENT surgical procedures with free flap reconstruction. We describe our data in terms of intraoperative hemodynamics management and rate of complications in both groups. Results: We have done a retrospective examination about 17 patient’s undergone surgical procedures in head and neck departments with free flaps reconstruction from November 2012 to February 2014. We had only one major complication (venous Rosella Bulgheroni1, Alessandro Bacuzzi1, Luca Guzzetti1*, Mauro Del Romano1, Dunia D’Onofrio1, Gaia Rossini1, Andrea Del Bosco1, Massimiliano Bianchi1, Raffaele Novario1, Marco Giudice2, Mario Cherubino3, Giovanni Cantone3 and Salvatore Cuffari1 1Anesthesia Department, University Hospital Varese, Italy 2Department of Surgical Sciences, University Hospital Varese, Italy 3Plastic and Reconstructive Surgery Department, University Hospital Varese, Italy The Intraoperative Hemodynamic Control through Functional Parameters in Free Flap Reconstruction in Head and Neck Surgery: Our Initial Expertise anastomosis failure) in the VIGILEO group. We’ve found that there are no statistical differences in amount of volume fluids infused (VIGILEO 477, 7 ml/h STANDARD group 490, 2 ml/h) between study groups. We have found a systematically use of vasoactive drugs in continuous infusion only in VIGILEO group. Discussion: Hemodynamic optimization has been related to a better outcome in surgical procedures with an improvement in microcirculation anastomosis. The role of functional hemodynamics parameters in ENT surgery with free flaps reconstruction is promising. Further assessments in large randomized trial are necessary.