The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-4329
+8 800 250-18-12
  • (toll-free number for subscriptions)
    Mon-Fri from 10 a.m. to 6 p.m.

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Filimonov M.S.

Vreden National Medical Research Center of Traumatology and Orthopedics

Abdiba N.V.

Vreden National Medical Research Center of Traumatology and Orthopedics

Fedorova Yu.A.

Pediatric Center “Lahta Junior”

Rodomanova L.A.

Vreden National Medical Research Center of Traumatology and Orthopedics

Effect of perioperative norepinephrine infusion on the outcomes after microsurgical free tissue grafting: a systematic review

Authors:

Filimonov M.S., Abdiba N.V., Fedorova Yu.A., Rodomanova L.A.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2025;(5): 98‑107

DOI: 10.17116/anaesthesiology202505198

Read: 1081 times

Download PDF (RU)
Download PDF
Contact the author
Table of contents

EFFECT OF PERIOPERATIVE NOREPINEPHRINE INFUSION ON THE OUTCOMES AFTER MICROSURGICAL FREE TISSUE GRAFTING: A SYSTEMATIC REVIEW
EFFECT OF PERIOPERATIVE NOREPINEPHRINE INFUSION ON THE OUTCOMES AFTER MICROSURGICAL FREE TISSUE GRAFTING: A SYSTEMATIC REVIEW

To cite this article:

Filimonov MS, Abdiba NV, Fedorova YuA, Rodomanova LA. Effect of perioperative norepinephrine infusion on the outcomes after microsurgical free tissue grafting: a systematic review. Russian Journal of Anesthesiology and Reanimatology. 2025;(5):98‑107. (In Russ., In Engl.)
https://doi.org/10.17116/anaesthesiology202505198

МСФ на ЯМ
Использование инфографики авторами научных работ
Close metadata
Recommended articles:
Anesthetic risk factors in reco­nstructive surgery for breast cancer. Russian Journal of Anesthesiology and Reanimatology. 2025;(4):37-46
The blood content of 25-OH vita­min D and biogenic amines in resi­dents of Arkhangelsk city. Russian Journal of Preventive Medi­cine. 2024;(11):108-114
A bala­nce between surgical mana­gement and therapy in a patient with severe sternomediastinitis complicated by heart failure and refractory septic shock. Piro­gov Russian Journal of Surgery. 2024;(12-2):166-172
Step-by-step medi­cal treatment for a severe facial shra­pnel injury. Russian Rhinology. 2024;(4):323-328
Resu­lts of replacing exte­nsive nerve defe­cts with synthetic conduits based on poly­lactide with poly­pyrrole in an expe­riment. Russian Journal of Operative Surgery and Clinical Anatomy. 2024;(4-2):24-32
Microsurgical treatment of 723 cere­bral aneurysms: a single-center prospective study. Burdenko's Journal of Neurosurgery. 2025;(3):60-67
Perioperative complications in surgery for craniosynostosis in children: a systematic review and meta-analysis. Burdenko's Journal of Neurosurgery. 2025;(3):114-121
Abstract:

The problem of maintaining target blood pressure in perioperative period after microsurgical interventions systematically requires catecholamine support (vasopressors). This leads to disputes about safety of norepinephrine after free tissue grafting.

OBJECTIVE

To determine the effect of perioperative norepinephrine infusion on the risk and incidence of postoperative complications after transplantation of free tissue complexes.

MATERIAL AND METHODS

We reviewed the eLibrary, PubMed (MEDLINE), Ovid, ScienceDirect, Google Scholar and Web of Science databases. When analyzing the risks of systematic bias, we used the Newcastle-Ottawa questionnaire for non-randomized clinical trials and the validated Cochrane RCT Assessment System questionnaire for randomized clinical trials. The meta-analysis was performed using the Open Meta-Analyst software.

RESULTS

The incidence of postoperative complications following perioperative norepinephrine infusion was 6%. A similar value was obtained in patients who did not receive vasopressor support. The pooled odds ratio was 0.62 (95% CI 0.22—1.79). The indicator was characterized by low heterogeneity (I2=0%, p=0.923).

CONCLUSION

There are no significant differences in the incidence of postoperative complications and redo interventions after transplantation of free tissue complexes followed by perioperative norepinephrine infusion.

Keywords:

microsurgery
free flaps
finger transplantation
vasopressor
norepinephrine
norepinephrine
reconstructive surgery
hand surgery
adrenergic agonist

Authors:

Filimonov M.S.

Vreden National Medical Research Center of Traumatology and Orthopedics

Abdiba N.V.

Vreden National Medical Research Center of Traumatology and Orthopedics

Fedorova Yu.A.

Pediatric Center “Lahta Junior”

Rodomanova L.A.

Vreden National Medical Research Center of Traumatology and Orthopedics

Received:

27.01.2025

Accepted:

24.03.2025

Close metadata

References:

  1. Grill FD, Wasmaier M, Mücke T, Ritschl LM, Wolff KD, Schneider G, Loeffelbein DJ, Kadera V. Identifying perioperative volume-related risk factors in head and neck surgeries with free flap reconstructions — An investigation with focus on the influence of red blood cell concentrates and noradrenaline use. Journal of Cranio-Maxillofacial Surgery. 2020;48(1):67-74.  https://doi.org/10.1016/j.jcms.2019.12.001
  2. Kelly DA, Reynolds M, Crantford C, Pestana IA. Impact of intraoperative vasopressor use in free tissue transfer for head, neck, and extremity reconstruction. Annals of Plastic Surgery. 2014;72(6). https://doi.org/10.1097/SAP.0000000000000076
  3. Vyas K, Wong L. Intraoperative management of free flaps: current practice. Annals of Plastic Surgery. 2014;72(6). https://doi.org/10.1097/SAP.0000000000000096
  4. Eley KA, Duncan Young J, Watt-Smith SR. Epinephrine, norepinephrine, dobutamine, and dopexamine effects on free flap skin blood flow. Plastic and Reconstructive Surgery. 2012;130(3):564-570.  https://doi.org/10.1097/PRS.0b013e31825dbf73
  5. Hong JP, Suh HSP. Discussion: Selective Intraoperative Vasopressor Use Is Not Associated with Increased Risk of DIEP Flap Complications. Plastic and Reconstructive Surgery. 2017;140(1):78e-79e.  https://doi.org/10.1097/PRS.0000000000003445
  6. Cordeiro PG, Sarrtamaria E, Hu QY, Heerdt P. Effects of vasoactive medications on the blood flow of island musculocutaneous flaps in swine. Annals of Plastic Surgery. 1997;39(5):524-531.  https://doi.org/10.1097/00000637-199711000-00013
  7. Banic A, Krejci V, Erni D, Wheatley AM, Sigurdsson GH. Effects of sodium nitroprusside and phenylephrine on blood flow in free musculocutaneous flaps during general anesthesia. Anesthesiology. 1999;90(1):147-155.  https://doi.org/10.1097/00000542-199901000-00020
  8. Sun TB, Kuo TBJ, Yang CCH. Nonparallel cutaneous microcirculatory responses to pharmacologic alterations of systemic arterial pressure in rats. Microsurgery. 2009;29(4):319-325.  https://doi.org/10.1002/MICR.20627
  9. Rajan S, Sudevan M, Kadapamannil D, Mohan A, Paul J, Kumar L. Does perioperative use of noradrenaline affect free flap outcome following reconstructive microvascular surgeries? A retrospective analysis. Anesthesia: Essays and Researches. 2019;13(1):79.  https://doi.org/10.4103/aer.aer_193_18
  10. Brinkman JN, Derks LH, Klimek M, Mureau MAM. Perioperative fluid management and use of vasoactive and antithrombotic agents in free flap surgery: a literature review and clinical recommendations. Journal of Reconstructive Microsurgery. 2013;29(6):357-366.  https://doi.org/10.1055/S-0033-1343955
  11. Haughey BH, Wilson E, Kluwe L, Piccirillo J, Fredrickson J, Sessions D, Spector G. Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngology — Head and Neck Surgery. 2001;125(1):10-17.  https://doi.org/10.1067/MHN.2001.116788
  12. Pattani KM, Byrne P, Boahene K, Richmon J. What makes a good flap go bad? A critical analysis of the literature of intraoperative factors related to free flap failure. Laryngoscope. 2010;120(4):717-723.  https://doi.org/10.1002/LARY.20825
  13. Rodomanova LA, Kochish AYu. The comparative analysis of efficiency of the early and late reconstructive microsurgical operations at patients with extensive posttraumatic defects of upper extremities. Travmatologiya i ortopediya Rossii. 2013;19(4):16-23. (In Russ.). https://doi.org/10.21823/2311-2905-2013--4-16-23
  14. Swanson EW, Cheng HT, Susarla SM, Yalanis GC, Lough DM, Johnson O 3rd, Tufaro AP, Manson PN, Sacks JM. Intraoperative Use of Vasopressors Is Safe in Head and Neck Free Tissue Transfer. Journal of Reconstructive Microsurgery. 2016;32(2):87-93.  https://doi.org/10.1055/s-0035-1563381
  15. Akita S, Kumamaru H, Motomura H, Mitsukawa N, Morimoto N, Sakuraba M. The volume-outcome relationship in free-flap reconstruction: A nationwide study based on the Clinical Database. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2023;85:500-507.  https://doi.org/10.1016/J.BJPS.2023.07.047
  16. Gardner JR, Gau V, Page P, Dunlap Q, King D, Crabtree D, Sunde J, Vural E, Moreno MA. Association of Continuous Intraoperative Vasopressor Use with Reoperation Rates in Head and Neck Free-Flap Reconstruction. JAMA Otolaryngology — Head and Neck Surgery. 2021;147(12):1059-1064. https://doi.org/10.1001/jamaoto.2021.1841
  17. Lee S, Ju JW, Yoon S, Lee HJ, Ha JH, Hong KY, Jin US, Chang H, Cho YJ. Norepinephrine preserved flap blood flow compared to phenylephrine in free transverse rectus abdominis myocutaneous flap breast reconstruction surgery: A randomized pilot study. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2023;83:438-447.  https://doi.org/10.1016/j.bjps.2023.04.080
  18. Raittinen L, Kääriäinen MT, Lopez JF, Pukander J, Laranne J. The Effect of Norepinephrine and Dopamine on Radial Forearm Flap Partial Tissue Oxygen Pressure and Microdialysate Metabolite Measurements: A Randomized Controlled Trial. Plastic and Reconstructive Surgery. 2016; 137(6):1016e-1023e. https://doi.org/10.1097/PRS.0000000000002176
  19. Anker AM, Prantl L, Strauss C, Brébant V, Heine N, Lamby P, Geis S, Schenkhoff F, Pawlik M, Klein SM. Vasopressor support vs. liberal fluid administration in deep inferior epigastric perforator (DIEP) free flap breast reconstruction — A randomized controlled trial. Clinical Hemorheology and Microcirculation. 2018;69(1-2):37-44.  https://doi.org/10.3233/CH-189129
  20. Anker AM, Prantl L, Strauss C, Brébant V, Schenkhoff F, Pawlik M, Vykoukal J, Klein SM. Assessment of DIEP Flap Perfusion with Intraoperative Indocyanine Green Fluorescence Imaging in Vasopressor-Dominated Hemodynamic Support Versus Liberal Fluid Administration: A Randomized Controlled Trial with Breast Cancer Patients. Annals of Surgical Oncology. 2020;27(2):399-406.  https://doi.org/10.1245/s10434-019-07758-1
  21. Rebrova OYu. Scale of reliability of evidence of the effectiveness and safety of medical and preventive interventions based on the design and methodological quality of studies. Rossijskij allergologicheskij zhurnal. 2018;15(3):25-29. (In Russ.). https://doi.org/10.36691/RJA147
  22. Rebrova OYu, Fedyaeva VK, Khachatryan GR. Adaptation and Validation of the Cochrane Questionnarie to Assess Risks of Bias in Randomized Controlled Trials. Medical Technologies. Assessment and Choice. 2015;1:9-17. (In Russ.).
  23. Beburishvili AG, Fedorov AV, Panin SI, Postolov MP. General Methodology of Meta-Analyses and data interpretation in Surgery. Pirogov Russian Journal of Surgery. 2019;(12):60-65. (In Russ.). https://doi.org/10.17116/hirurgia201912160
  24. Vincent A, Sawhney R, Ducic Y. Free Tissue Transfer Reconstruction: Perioperative Care of Free Flap Patients. Seminars in Plastic Surgery. 2019; 33(1):5-12.  https://doi.org/10.1055/s-0038-1676824
  25. Hagau N, Longrois DAN. Anesthesia for free vascularized tissue transfer. Microsurgery. 2009;29(2):161-167.  https://doi.org/10.1002/micr.20584
  26. Michelle L, Bitner BF, Pang JC, Berger MH, Haidar YM, Rajan GR, Tjoa T. Outcomes of perioperative vasopressor use for hemodynamic management of patients undergoing free flap surgery: A systematic review and meta-analysis. Head and Neck. 2023;45(3):721-732.  https://doi.org/10.1002/hed.27289
  27. Banic A, Krejci V, Erni D, Petersen-Felix S, Sigurdsson GH. Effects of extradural anesthesia on microcirculatory blood flow in free latissimus dorsi musculocutaneous flaps in pigs. Plastic and Reconstructive Surgery. 1997;100(4):945-956.  https://doi.org/10.1097/00006534-199709001-00017
  28. Massey MF, Gupta DK. The effects of systemic phenylephrine and epinephrine on pedicle artery and microvascular perfusion in a pig model of myoadipocutaneous rotational flaps. Plastic and Reconstructive Surgery. 2007;120(5):1289-1299. https://doi.org/10.1097/01.PRS.0000279371.63439.8D
  29. Lecoq JPH, Joris JL, Nelissen XP, Lamy ML, Heymans OY. Effect of adrenergic stimulation on cutaneous microcirculation immediately after surgical adventitiectomy in a rat skin flap model. Microsurgery. 2008;28:480-486.  https://doi.org/10.1002/micr.20528
  30. Cannon WB, Rosenblueth A. The Supersensitivity of Denervated Structures: A Law of Denervation. M.: Izdatel’stvo inostrannoj literatury; 1951:205-223. (In Russ.).
  31. Eley KA, Young JD, Watt-Smith SR. Power spectral analysis of the effects of epinephrine, norepinephrine, dobutamine and dopexamine on microcirculation following free tissue transfer. Microsurgery. 2013;33(4):275-281.  https://doi.org/10.1002/micr.22072
  32. Dorje P, Adhikary G, Tempe DK. Avoiding latrogenic hyperchloremic acidosis — call for a new crystalloid fluid. Anesthesiology. 2000;92(2):625-626.  https://doi.org/10.1097/00000542-200002000-00055
  33. Buzzard L, Schreiber M. Trauma-induced coagulopathy: What you need to know. Journal of Trauma and Acute Care Surgery. 2024;96(2):179-185.  https://doi.org/10.1097/TA.0000000000004170
  34. Zhong T, Neinstein R, Massey C, McCluskey SA, Lipa J, Neligan P, Hofer SOP. Intravenous fluid infusion rate in microsurgical breast reconstruction: important lessons learned from 354 free flaps. Plastic and Reconstructive Surgery. 2011;128(6):1153-1160. https://doi.org/10.1097/PRS.0B013E318221DA56
  35. Mittal A, Bhardwaj M, Arora M, Bhageria V. Anesthetic consideration in a postchemotherapy pediatric patient for segmental mandibulectomy with free fibula reconstruction. The Indian Anaesthetists Forum. 2017;18(2):69.  https://doi.org/10.4103/THEIAFORUM.THEIAFORUM_35_17
  36. Stepanovs J, Ozolina A, Rovite V, Mamaja B, Vanags I. Factors Affecting the Risk of Free Flap Failure in Microvascular Surgery. Proceedings of the Latvian Academy of Sciences, Section B: Natural, Exact, and Applied Sciences. 2016;70(6):356-364.  https://doi.org/10.1515/prolas-2016-0039
  37. Goh CSL, Ng MJM, Song DH, Ooi ASH. Perioperative Vasopressor Use in Free Flap Surgery: A Systematic Review and Meta-Analysis. Journal of Reconstructive Microsurgery. 2019;35(7):529-540.  https://doi.org/10.1055/S-0039-1687914
  38. Rajan S, Suppiah RK, Paul J, Kumar L. Anaesthetic management of bilateral hand transplantation. Indian Journal of Anaesthesiology. 2015;59(12):819-820.  https://doi.org/10.4103/0019-5049.171593
  39. Fang L, Liu J, Yu C, Hanasono MM, Zheng G, Yu P. Intraoperative Use of Vasopressors Does Not Increase the Risk of Free Flap Compromise and Failure in Cancer Patients. Annals of Surgery. 2018;268(2):379-384.  https://doi.org/10.1097/SLA.0000000000002295
Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.