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Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al. | ||
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| 4. Stellate ganglion block provides sympathetic blockade in cases in which postoperative vasospasm may be a problem. This block may also be used to treat reflex sympathetic dystrophy that may occasionally occur in the postoperative course. Although it is rare, the cervical sympathetic block has been used intraoperatively while the patient is receiving inhalation anesthesia, but it is difficult to determine the effects of the block because the usual Horner's syndrome is not seen, and the cutaneous vessels are already dilated from the general anesthetic. If it is anticipated that a series of blocks will be necessary, a percutaneous catheter can be placed near the stellate ganglion and repeated injection given through the catheter. We have had good results using an 18 gauge intercath placed at the C6 level by the paratracheal technique.15 The catheter is sutured in place with a sterile dressing to secure the tape to the neck. These catheters have been left in place up to 7 days; usually injection of bivocaine 0.25% every 12 hours maintains the sympathetic blockade.
There is much still to be defined regarding anesthesia for microvascular surgery. The issues of general anesthetics versus regional techniques, invasive versus noninvasive monitoring, to use or not to use vasoactive drugs other than the general anesthetics, continue to be topics of debate. At the Davies Medical Center, we are approaching our 2000th microvascular anesthetic. We have an excellent success rate and a virtually nonexistent complication rate. With this in mind, we will continue to provide for our patients in the manner with which we have evolved, that is, a noninvasive, carefully thought-out general anesthetic with meticulous care to the basics, until evidence for a superior method is presented. |
References 1. Eger, E.: Is the continued use of nitrous oxide warranted? 1986 ASA Refresher Course Lectures, Hartford, Conn. American Society of Anesthesiologists, 1986, p. 531. 2. Christopher, A., Cox, R., Mayou, B., et al.: The role of anesthetic management in enhancing peripheral blood flow inpatients undergoing free flap transfer. Annals Roy. Col. Surg. 67:177-179, 1985. 3. McDonald, D.J.F.: Anesthesia for microvascular surgery. Br. J. Anaesth. 57:904-912, 1985. 4. Robbins, D.W.: The anesthetic management of patients undergoing free flap transfer. Br. J. Plast. Surg. 36:231234, 1983. 5. Eger, E.: Isoflurane (ForaneR) A compendium and reference. Madison, Wisconsin, Ohio Medical Products, 1981. 6. Jakubowski, L., and Murray, D.: Anesthesia for microsurgery. S. Afr. Med. 1. 67:581-584, 1985. 7. Cohen, M.: An investigation into shivering following anesthesia. Proc. Roy. Soc. Med. 60:752, 1967. |
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