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Introduction:
Postoperative use of vasopressors has long been debated in the care of free flap patients. Despite data suggesting more favorable outcomes with vasopressor over fluids for maintaining blood pressure and flap flow, there remains widespread reservation to this practice. Studies have demonstrated that norepinephrine and dobutamine cause increased free flap perfusion in a dose dependant manner compared to dopamine and epinephrine which have been shown to decrease flap blood flow. In this study we report perioperative outcomes of head and neck free flap patients following low dose dopamine infusion.
Methods:
A retrospective study was performed on all head and neck free flap patients in the surgical intensive care unit from March 2013-March 2015. Fifteen patients were identified who were treated with dopamine postoperatively. Data collected included type of free flap, dose/duration of dopamine, pre and post dopamine mean arterial pressure (MAP), heart rate (HR), urine output (UOP), and fluid boluses. All flap related complications and adverse reactions were recorded.
Results:
Dopamine dose averaged 4.1 mcg/kg/min (STD 1.0) over a duration of 20.8 hours (STD 26.1). Pre-dopamine MAP was 62.2 (STD 6.0), MAP on dopamine was 76.3 (STD 4.7), pre-dopamine HR was 82.3 (STD 17.4), HR on dopamine was 89.6 (STD 18.4), dopamine infusion had no effect on urine output. Fluid boluses pre-dopamine included an average of 1.2L crystalloid (STD 791.7), 183cc of albumin 25%, 583cc (STD 381) of albumin 5%. While on dopamine patients received an average of 183cc fluid bolus (STD 375). No patients received albumin while on dopamine. There were no cases of flap failure or adverse reactions reported.
Conclusions:
This study demonstrates that low dose dopamine (<5mcg/kg/min) provides adequate inotropic and pressor effects to significantly elevate mean arterial pressure and reduce fluid bolus requirements in patients following free flaps. The use of low dose dopamine minimally effected urine output and heart rate. Previous studies have supported the use of norepinephrine and dobutamine while suggesting that dopamine and epinephrine decrease flap blood flow. This study demonstrates the safety and efficacy of using low dose dopamine in head and neck free flap patients.