Effects of vasopressors on circulation in the porcine abdominal island flap model
During reconstructive surgical procedures, systemic vasopressors are frequently used to maintain normal blood pressure. However, questions have arisen regarding the pharmacologic effects of vasopressors on flap circulation. Many plastic surgeons have expressed concern about the possibility of impair...
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| Veröffentlicht in: | Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2019-10, Vol.72 (10), p.1653-1660 |
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| container_title | Journal of plastic, reconstructive & aesthetic surgery |
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| creator | Chung, Jae-Ho Cheon, Jeong-Hyun Kim, Min-Sook Min, Doo-Jae Yoon, Eul-Sik Lee, Byung-Il Park, Seung-Ha Kim, Deok-Woo |
| description | During reconstructive surgical procedures, systemic vasopressors are frequently used to maintain normal blood pressure. However, questions have arisen regarding the pharmacologic effects of vasopressors on flap circulation. Many plastic surgeons have expressed concern about the possibility of impaired flap circulation caused by the vasoconstrictive effect of the drugs. However, the opposing argument exists that the increase in mean arterial pressure from vasoactive agents may improve flap perfusion. The purpose of this study was to evaluate the effect of commonly used vasopressors on flap circulation.
The vertical rectus abdominis myocutaneous (VRAM) island flap was raised in five female pigs (38.2∼40.7 kg). Hemodynamic parameters were measured continuously by a carotid arterial catheter. A bi-directional transonic vascular doppler flow probe and Laser Doppler perfusion monitor (LDPM) unit were applied to record the continuous change in pedicle artery flow and microvascular perfusion following intravenous administration of dopamine (3, 5, 10µg/kg/minute), dobutamine (1.25, 2.5, 5µg/kg/minute), and norepinephrine (0.05, 0.1, 0.2µg/kg/minute).
Both microvascular perfusion and pedicle flow were generally proportional to the mean arterial pressure, and all three vasopressors improved flap perfusion and pedicle flow without deleterious effects. Norepinephrine showed the highest microvascular perfusion and dobutamine showed the highest pedicle flow rate. The mean blood pressure was the only statistically significant factor to affect both microvascular perfusion and pedicle flow (p |
| doi_str_mv | 10.1016/j.bjps.2019.06.009 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2270004208</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1748681519302876</els_id><sourcerecordid>2270004208</sourcerecordid><originalsourceid>FETCH-LOGICAL-c356t-1bc6b4a0484a36170b11ee0b75ffa443b52574239bfd22ade6663b7a671b6f113</originalsourceid><addsrcrecordid>eNp9kEtLxTAQhYMovv-AC8nSTWvebcGNiC8QRNB1SNIJ5tI2NekV_PfmctWlq5mBcw5zPoTOKKkpoepyVdvVnGtGaFcTVRPS7aBD2jZtRSTvdsveiLZSLZUH6CjnFSGCUyH30QGnvJNCqkP0cus9uCXj6PGnyXFOkHNM5Z6wC8mtB7OEsocJL--A55hcmAAb28cxTGbAIQ9m6rEfzIzH2MNwgva8GTKc_sxj9HZ3-3rzUD093z_eXD9Vjku1VNQ6ZYUhohWGK9oQSykAsY303gjBrWSyEYx31veMmR6UUtw2RjXUKk8pP0YX29w5xY815EWPITsYyjsQ11kz1pDSmJG2SNlW6lLMOYHXcwqjSV-aEr1BqVd6g1JvUGqidEFZTOc_-Ws7Qv9n-WVXBFdbAZSWnwGSzi7A5KAPqSDVfQz_5X8DUreFGA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2270004208</pqid></control><display><type>article</type><title>Effects of vasopressors on circulation in the porcine abdominal island flap model</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Chung, Jae-Ho ; Cheon, Jeong-Hyun ; Kim, Min-Sook ; Min, Doo-Jae ; Yoon, Eul-Sik ; Lee, Byung-Il ; Park, Seung-Ha ; Kim, Deok-Woo</creator><creatorcontrib>Chung, Jae-Ho ; Cheon, Jeong-Hyun ; Kim, Min-Sook ; Min, Doo-Jae ; Yoon, Eul-Sik ; Lee, Byung-Il ; Park, Seung-Ha ; Kim, Deok-Woo</creatorcontrib><description>During reconstructive surgical procedures, systemic vasopressors are frequently used to maintain normal blood pressure. However, questions have arisen regarding the pharmacologic effects of vasopressors on flap circulation. Many plastic surgeons have expressed concern about the possibility of impaired flap circulation caused by the vasoconstrictive effect of the drugs. However, the opposing argument exists that the increase in mean arterial pressure from vasoactive agents may improve flap perfusion. The purpose of this study was to evaluate the effect of commonly used vasopressors on flap circulation.
The vertical rectus abdominis myocutaneous (VRAM) island flap was raised in five female pigs (38.2∼40.7 kg). Hemodynamic parameters were measured continuously by a carotid arterial catheter. A bi-directional transonic vascular doppler flow probe and Laser Doppler perfusion monitor (LDPM) unit were applied to record the continuous change in pedicle artery flow and microvascular perfusion following intravenous administration of dopamine (3, 5, 10µg/kg/minute), dobutamine (1.25, 2.5, 5µg/kg/minute), and norepinephrine (0.05, 0.1, 0.2µg/kg/minute).
Both microvascular perfusion and pedicle flow were generally proportional to the mean arterial pressure, and all three vasopressors improved flap perfusion and pedicle flow without deleterious effects. Norepinephrine showed the highest microvascular perfusion and dobutamine showed the highest pedicle flow rate. The mean blood pressure was the only statistically significant factor to affect both microvascular perfusion and pedicle flow (p < 0.0001).
Our results strongly suggest that the foremost three vasopressors can be used for flap surgery without deterioration, and that the maintenance of adequate systemic blood pressure is crucial for good flap circulation.</description><identifier>ISSN: 1748-6815</identifier><identifier>EISSN: 1878-0539</identifier><identifier>DOI: 10.1016/j.bjps.2019.06.009</identifier><identifier>PMID: 31395456</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Animals ; Blood Flow Velocity - drug effects ; Blood Pressure - drug effects ; Blood supply ; Dopamine - pharmacology ; Female ; Hemodynamics - drug effects ; Infusions, Intravenous ; Laser-doppler flowmetry ; Laser-Doppler Flowmetry - methods ; Models, Animal ; Myocutaneous Flap - blood supply ; Myocutaneous Flap - transplantation ; Perfusion ; Rectus Abdominis - blood supply ; Rectus Abdominis - surgery ; Regional Blood Flow - drug effects ; Risk Assessment ; Sensitivity and Specificity ; Surgical flaps ; Surgical Flaps - blood supply ; Surgical Flaps - transplantation ; Swine ; Vasoconstrictor agents ; Vasoconstrictor Agents - pharmacology</subject><ispartof>Journal of plastic, reconstructive & aesthetic surgery, 2019-10, Vol.72 (10), p.1653-1660</ispartof><rights>2019</rights><rights>Copyright © 2019. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-1bc6b4a0484a36170b11ee0b75ffa443b52574239bfd22ade6663b7a671b6f113</citedby><cites>FETCH-LOGICAL-c356t-1bc6b4a0484a36170b11ee0b75ffa443b52574239bfd22ade6663b7a671b6f113</cites><orcidid>0000-0001-5734-6625 ; 0000-0002-8351-2444</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.bjps.2019.06.009$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31395456$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chung, Jae-Ho</creatorcontrib><creatorcontrib>Cheon, Jeong-Hyun</creatorcontrib><creatorcontrib>Kim, Min-Sook</creatorcontrib><creatorcontrib>Min, Doo-Jae</creatorcontrib><creatorcontrib>Yoon, Eul-Sik</creatorcontrib><creatorcontrib>Lee, Byung-Il</creatorcontrib><creatorcontrib>Park, Seung-Ha</creatorcontrib><creatorcontrib>Kim, Deok-Woo</creatorcontrib><title>Effects of vasopressors on circulation in the porcine abdominal island flap model</title><title>Journal of plastic, reconstructive & aesthetic surgery</title><addtitle>J Plast Reconstr Aesthet Surg</addtitle><description>During reconstructive surgical procedures, systemic vasopressors are frequently used to maintain normal blood pressure. However, questions have arisen regarding the pharmacologic effects of vasopressors on flap circulation. Many plastic surgeons have expressed concern about the possibility of impaired flap circulation caused by the vasoconstrictive effect of the drugs. However, the opposing argument exists that the increase in mean arterial pressure from vasoactive agents may improve flap perfusion. The purpose of this study was to evaluate the effect of commonly used vasopressors on flap circulation.
The vertical rectus abdominis myocutaneous (VRAM) island flap was raised in five female pigs (38.2∼40.7 kg). Hemodynamic parameters were measured continuously by a carotid arterial catheter. A bi-directional transonic vascular doppler flow probe and Laser Doppler perfusion monitor (LDPM) unit were applied to record the continuous change in pedicle artery flow and microvascular perfusion following intravenous administration of dopamine (3, 5, 10µg/kg/minute), dobutamine (1.25, 2.5, 5µg/kg/minute), and norepinephrine (0.05, 0.1, 0.2µg/kg/minute).
Both microvascular perfusion and pedicle flow were generally proportional to the mean arterial pressure, and all three vasopressors improved flap perfusion and pedicle flow without deleterious effects. Norepinephrine showed the highest microvascular perfusion and dobutamine showed the highest pedicle flow rate. The mean blood pressure was the only statistically significant factor to affect both microvascular perfusion and pedicle flow (p < 0.0001).
Our results strongly suggest that the foremost three vasopressors can be used for flap surgery without deterioration, and that the maintenance of adequate systemic blood pressure is crucial for good flap circulation.</description><subject>Animals</subject><subject>Blood Flow Velocity - drug effects</subject><subject>Blood Pressure - drug effects</subject><subject>Blood supply</subject><subject>Dopamine - pharmacology</subject><subject>Female</subject><subject>Hemodynamics - drug effects</subject><subject>Infusions, Intravenous</subject><subject>Laser-doppler flowmetry</subject><subject>Laser-Doppler Flowmetry - methods</subject><subject>Models, Animal</subject><subject>Myocutaneous Flap - blood supply</subject><subject>Myocutaneous Flap - transplantation</subject><subject>Perfusion</subject><subject>Rectus Abdominis - blood supply</subject><subject>Rectus Abdominis - surgery</subject><subject>Regional Blood Flow - drug effects</subject><subject>Risk Assessment</subject><subject>Sensitivity and Specificity</subject><subject>Surgical flaps</subject><subject>Surgical Flaps - blood supply</subject><subject>Surgical Flaps - transplantation</subject><subject>Swine</subject><subject>Vasoconstrictor agents</subject><subject>Vasoconstrictor Agents - pharmacology</subject><issn>1748-6815</issn><issn>1878-0539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtLxTAQhYMovv-AC8nSTWvebcGNiC8QRNB1SNIJ5tI2NekV_PfmctWlq5mBcw5zPoTOKKkpoepyVdvVnGtGaFcTVRPS7aBD2jZtRSTvdsveiLZSLZUH6CjnFSGCUyH30QGnvJNCqkP0cus9uCXj6PGnyXFOkHNM5Z6wC8mtB7OEsocJL--A55hcmAAb28cxTGbAIQ9m6rEfzIzH2MNwgva8GTKc_sxj9HZ3-3rzUD093z_eXD9Vjku1VNQ6ZYUhohWGK9oQSykAsY303gjBrWSyEYx31veMmR6UUtw2RjXUKk8pP0YX29w5xY815EWPITsYyjsQ11kz1pDSmJG2SNlW6lLMOYHXcwqjSV-aEr1BqVd6g1JvUGqidEFZTOc_-Ws7Qv9n-WVXBFdbAZSWnwGSzi7A5KAPqSDVfQz_5X8DUreFGA</recordid><startdate>201910</startdate><enddate>201910</enddate><creator>Chung, Jae-Ho</creator><creator>Cheon, Jeong-Hyun</creator><creator>Kim, Min-Sook</creator><creator>Min, Doo-Jae</creator><creator>Yoon, Eul-Sik</creator><creator>Lee, Byung-Il</creator><creator>Park, Seung-Ha</creator><creator>Kim, Deok-Woo</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5734-6625</orcidid><orcidid>https://orcid.org/0000-0002-8351-2444</orcidid></search><sort><creationdate>201910</creationdate><title>Effects of vasopressors on circulation in the porcine abdominal island flap model</title><author>Chung, Jae-Ho ; Cheon, Jeong-Hyun ; Kim, Min-Sook ; Min, Doo-Jae ; Yoon, Eul-Sik ; Lee, Byung-Il ; Park, Seung-Ha ; Kim, Deok-Woo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-1bc6b4a0484a36170b11ee0b75ffa443b52574239bfd22ade6663b7a671b6f113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Animals</topic><topic>Blood Flow Velocity - drug effects</topic><topic>Blood Pressure - drug effects</topic><topic>Blood supply</topic><topic>Dopamine - pharmacology</topic><topic>Female</topic><topic>Hemodynamics - drug effects</topic><topic>Infusions, Intravenous</topic><topic>Laser-doppler flowmetry</topic><topic>Laser-Doppler Flowmetry - methods</topic><topic>Models, Animal</topic><topic>Myocutaneous Flap - blood supply</topic><topic>Myocutaneous Flap - transplantation</topic><topic>Perfusion</topic><topic>Rectus Abdominis - blood supply</topic><topic>Rectus Abdominis - surgery</topic><topic>Regional Blood Flow - drug effects</topic><topic>Risk Assessment</topic><topic>Sensitivity and Specificity</topic><topic>Surgical flaps</topic><topic>Surgical Flaps - blood supply</topic><topic>Surgical Flaps - transplantation</topic><topic>Swine</topic><topic>Vasoconstrictor agents</topic><topic>Vasoconstrictor Agents - pharmacology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chung, Jae-Ho</creatorcontrib><creatorcontrib>Cheon, Jeong-Hyun</creatorcontrib><creatorcontrib>Kim, Min-Sook</creatorcontrib><creatorcontrib>Min, Doo-Jae</creatorcontrib><creatorcontrib>Yoon, Eul-Sik</creatorcontrib><creatorcontrib>Lee, Byung-Il</creatorcontrib><creatorcontrib>Park, Seung-Ha</creatorcontrib><creatorcontrib>Kim, Deok-Woo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of plastic, reconstructive & aesthetic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chung, Jae-Ho</au><au>Cheon, Jeong-Hyun</au><au>Kim, Min-Sook</au><au>Min, Doo-Jae</au><au>Yoon, Eul-Sik</au><au>Lee, Byung-Il</au><au>Park, Seung-Ha</au><au>Kim, Deok-Woo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of vasopressors on circulation in the porcine abdominal island flap model</atitle><jtitle>Journal of plastic, reconstructive & aesthetic surgery</jtitle><addtitle>J Plast Reconstr Aesthet Surg</addtitle><date>2019-10</date><risdate>2019</risdate><volume>72</volume><issue>10</issue><spage>1653</spage><epage>1660</epage><pages>1653-1660</pages><issn>1748-6815</issn><eissn>1878-0539</eissn><abstract>During reconstructive surgical procedures, systemic vasopressors are frequently used to maintain normal blood pressure. However, questions have arisen regarding the pharmacologic effects of vasopressors on flap circulation. Many plastic surgeons have expressed concern about the possibility of impaired flap circulation caused by the vasoconstrictive effect of the drugs. However, the opposing argument exists that the increase in mean arterial pressure from vasoactive agents may improve flap perfusion. The purpose of this study was to evaluate the effect of commonly used vasopressors on flap circulation.
The vertical rectus abdominis myocutaneous (VRAM) island flap was raised in five female pigs (38.2∼40.7 kg). Hemodynamic parameters were measured continuously by a carotid arterial catheter. A bi-directional transonic vascular doppler flow probe and Laser Doppler perfusion monitor (LDPM) unit were applied to record the continuous change in pedicle artery flow and microvascular perfusion following intravenous administration of dopamine (3, 5, 10µg/kg/minute), dobutamine (1.25, 2.5, 5µg/kg/minute), and norepinephrine (0.05, 0.1, 0.2µg/kg/minute).
Both microvascular perfusion and pedicle flow were generally proportional to the mean arterial pressure, and all three vasopressors improved flap perfusion and pedicle flow without deleterious effects. Norepinephrine showed the highest microvascular perfusion and dobutamine showed the highest pedicle flow rate. The mean blood pressure was the only statistically significant factor to affect both microvascular perfusion and pedicle flow (p < 0.0001).
Our results strongly suggest that the foremost three vasopressors can be used for flap surgery without deterioration, and that the maintenance of adequate systemic blood pressure is crucial for good flap circulation.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>31395456</pmid><doi>10.1016/j.bjps.2019.06.009</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-5734-6625</orcidid><orcidid>https://orcid.org/0000-0002-8351-2444</orcidid></addata></record> |
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| subjects | Animals Blood Flow Velocity - drug effects Blood Pressure - drug effects Blood supply Dopamine - pharmacology Female Hemodynamics - drug effects Infusions, Intravenous Laser-doppler flowmetry Laser-Doppler Flowmetry - methods Models, Animal Myocutaneous Flap - blood supply Myocutaneous Flap - transplantation Perfusion Rectus Abdominis - blood supply Rectus Abdominis - surgery Regional Blood Flow - drug effects Risk Assessment Sensitivity and Specificity Surgical flaps Surgical Flaps - blood supply Surgical Flaps - transplantation Swine Vasoconstrictor agents Vasoconstrictor Agents - pharmacology |
| title | Effects of vasopressors on circulation in the porcine abdominal island flap model |
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