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Plastic surgery (Free flaps (Prolonged anaesthesia (Vascular access: must…
Plastic surgery
Free flaps
Prolonged anaesthesia
Vascular access: must not interfere with site of surgery. Art line preferable. At least one large bore peripheral cannula
Fluid balance: IDC essential. Careful monitoring of balance and blood losses (particularly in kids and peeps with poor CVS fx)
Temperature: Monitor core temp and maintain (low FGF, HME, warmed IVT, warm ambient temperature e.g. 24 deg, and FAW)
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Post op care: req. close observation, invasive monitoring and reg ABGs
Limited patient access
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Monitoring: ECG leads, pulse ox and BP cuff may be difficult to position
Vascular access: position cannula away from operative field, fem vessels or foot if needed, may need long extension set
Blood loss
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The initial dissection is usually the period of most blood loss (moderate hypotensive technique may be required)
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Keep track by weighing swabs, visual estimstion and regular Hb levels
Optimising conditions for flap survival: keep patient warm, well filled and pain free
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Removal of skin lesions
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Sedation may be required in anxious patients or for longer procedures (Propofol TCI with a small dose of Midaz)