Abstract
Appropriate fluid balance is an important factor in the survival of free flaps, and
recently there has been a shift towards more conservative fluid regimens. Several
surgical specialties have made extensive use of the relatively non-invasive method
of measuring cardiac output (CO) to optimise fluid balance during and after surgery,
which has resulted in a shorter hospital stay, but little has been published in head
and neck surgery. To ascertain its use in the head and neck we sent a postal questionnaire
to the anaesthetic departments of 40 major head and neck units identified from the
2010 database of the British Association of Oral and Maxillofacial Surgeons (BAOMS).
Questions were asked about the number of free flaps done in the unit each year, the
monitoring of central venous and arterial blood pressure (and inotrope protocols),
optimal target variables, and whether CO was monitored (with type of device). Thirty-two
units responded (80%). While 26 units (81%) routinely monitored central venous pressure
(CVP), CO was monitored in only 3 units (9%). There was a wide range of responses
in relation to optimal variables and use of inotropes. As with other specialties,
it is likely that CO monitoring will become widely used in head and neck reconstructive
surgery. Not only does it enhance fluid optimisation, but it may also reduce hospital
stay and morbidity. Appropriate clinical studies are urgently needed to evaluate its
use in our specialty.
Keywords
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Article info
Publication history
Published online: September 22, 2011
Accepted:
August 16,
2011
Identification
Copyright
© 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
