{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T10:23:50Z","timestamp":1773829430340,"version":"3.50.1"},"reference-count":27,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T00:00:00Z","timestamp":1702857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: In head and neck reconstructive surgery, postoperative complications are a well-known concern. Methods: We examined 46 patients who underwent ablative surgery and received fibula free flap reconstruction. The main focus was to assess the influence of intraoperative blood pressure fluctuations and the administration of inotropic drugs on complications, either related to the flap or systemic, serving as the primary endpoint. Results: Utilizing logistic regression models, we identified that intraoperative mean arterial blood pressure (MAP) drops did not correlate with the occurrence of either flap-related complications (MAP &lt; 70, p = 0.79; MAP &lt; 65, p = 0.865; MAP &lt; 60, p = 0.803; MAP &lt; 55, p = 0.937) or systemic medical complications (MAP &lt; 70, p = 0.559; MAP &lt; 65, p = 0.396; MAP &lt; 60, p = 0.211; MAP &lt; 55, p = 0.936). The occurrence of flap-related complications significantly increased if a higher dosage of dobutamine was administered (median 27.5 (IQR 0\u201347.5) vs. 62 (38\u2013109) mg, p = 0.019) but not if norepinephrine was administered (p = 0.493). This correlation was especially noticeable given the uptick in complications associated with fluid overload (3692 (3101\u20134388) vs. 4859 (3555\u20136216) mL, p = 0.026). Conclusion: Intraoperative and immediate postoperative blood pressure fluctuations are common but are not directly associated with flap-related complications; however, dobutamine application as well as fluid overload may impact flap-specific complications.<\/jats:p>","DOI":"10.3390\/jcm12247753","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T10:04:47Z","timestamp":1702893887000},"page":"7753","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The Role of Intraoperative and Early Postoperative Blood Pressure Variations, Fluid Balance and Inotropics in Fibula Free Flap Head and Neck Reconstruction: A Retrospective Analysis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2640-2652","authenticated-orcid":false,"given":"John-Patrik","family":"Burkhard","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland"},{"name":"Limmat Cleft- and Craniofacial Center Zurich, 8005 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alena","family":"Wepfer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7700-557X","authenticated-orcid":false,"given":"Lukas M.","family":"L\u00f6ffel","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland"},{"name":"Department of Anesthesiology, Lindenhof Hospital Bern, 3012 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6108-6923","authenticated-orcid":false,"given":"Kaspar F.","family":"Bachmann","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3704-6785","authenticated-orcid":false,"given":"Patrick Y.","family":"Wuethrich","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1001\/jamaoto.2016.2981","article-title":"Optimal Perioperative Care in Major Head and Neck Cancer Surgery with Free Flap Reconstruction: A Consensus Review and Recommendations from the Enhanced Recovery after Surgery Society","volume":"143","author":"Dort","year":"2017","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"771282","DOI":"10.3389\/fsurg.2021.771282","article-title":"Proposed Prediction Model and Nomogram for Systemic Complications in Patients Undergoing Free Flap Head and Neck Reconstruction","volume":"8","author":"Burkhard","year":"2021","journal-title":"Front. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5541","DOI":"10.1007\/s00784-021-03864-1","article-title":"Perioperative Predictors of Early Surgical Revision and Flap-Related Complications after Microvascular Free Tissue Transfer in Head and Neck Reconstructions: A Retrospective Observational Series","volume":"25","author":"Burkhard","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s00238-010-0466-9","article-title":"Perioperative Fluid Overload Increases Anastomosis Thrombosis in the Free TRAM Flap Used for Breast Reconstruction","volume":"34","author":"Booi","year":"2011","journal-title":"Eur. J. Plast. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2334","DOI":"10.1002\/hed.25190","article-title":"Intraoperative Hypotension and Flap Loss in Free Tissue Transfer Surgery of the Head and Neck","volume":"40","author":"Kass","year":"2018","journal-title":"Head Neck"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1002\/micr.30061","article-title":"Higher Perioperative Fluid Administration Is Associated with Increased Rates of Complications Following Head and Neck Microvascular Reconstruction with Fibular Free Flaps: Fluid Administration in Microvascular Reconstruction","volume":"37","author":"Ettinger","year":"2017","journal-title":"Microsurgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S220","DOI":"10.1097\/SAP.0000000000000096","article-title":"Intraoperative Management of Free Flaps: Current Practice","volume":"72","author":"Vyas","year":"2014","journal-title":"Ann. Plast. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/00000542-199901000-00020","article-title":"Effects of Sodium Nitroprusside and Phenylephrine on Blood Flow in Free Musculocutaneous Flaps during General Anesthesia","volume":"90","author":"Banic","year":"1999","journal-title":"Anesthesiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1055\/s-0039-1687914","article-title":"Perioperative Vasopressor Use in Free Flap Surgery: A Systematic Review and Meta-Analysis","volume":"35","author":"Goh","year":"2019","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/micr.30677","article-title":"Intraoperative Vasopressors in Head and Neck Free Flap Reconstruction","volume":"41","author":"Taylor","year":"2021","journal-title":"Microsurgery"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1080\/2000656X.2021.1873796","article-title":"Avoiding the Night Terrors: The Effect of Circadian Rhythm on Post-Operative Urine Output and Blood Pressure in Free Flap Patients","volume":"55","author":"Foong","year":"2021","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1053\/j.jvca.2016.12.002","article-title":"Relationship Between Intraoperative Hypotension and Acute Kidney Injury After Living Donor Liver Transplantation: A Retrospective Analysis","volume":"31","author":"Mizota","year":"2017","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/ALN.0000000000000765","article-title":"Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery","volume":"123","author":"Sun","year":"2015","journal-title":"Anesthesiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1093\/bja\/aeu458","article-title":"Impact of Intraoperative Hypotension and Blood Pressure Fluctuations on Early Postoperative Delirium after Non-Cardiac Surgery","volume":"115","author":"Hirsch","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1186\/s40001-023-01367-1","article-title":"Influence of Perioperative Blood Pressure Regulation on Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction","volume":"28","author":"Ooms","year":"2023","journal-title":"Eur. J. Med. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/ALN.0000000000000922","article-title":"Association between Intraoperative Hypotension and Myocardial Injury after Vascular Surgery","volume":"124","author":"Wijeysundera","year":"2016","journal-title":"Anesthesiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/ALN.0000000000001432","article-title":"Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery","volume":"126","author":"Salmasi","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_18","first-page":"604","article-title":"Association of Intraoperative Blood Pressure Instability with Adverse Outcomes after Liver Transplantation","volume":"79","author":"Lin","year":"2013","journal-title":"Minerva Anestesiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1055\/s-0038-1648244","article-title":"Effects of Transfusion on Free Flap Survival: Searching for an Optimal Hemoglobin Threshold for Transfusion","volume":"34","author":"Kim","year":"2018","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1177\/0194599814564366","article-title":"Characteristics and Intraoperative Treatments Associated with Head and Neck Free Tissue Transfer Complications and Failures","volume":"152","author":"Hand","year":"2015","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Huber, M., Furrer, M.A., Jardot, F., Engel, D., Beilstein, C.M., Burkhard, F.C., and Wuethrich, P.Y. (2023). Impact of Intraoperative Fluid Balance and Norepinephrine on Postoperative Acute Kidney Injury after Cystectomy and Urinary Diversion over Two Decades: A Retrospective Observational Cohort Study. JCM, 12.","DOI":"10.3390\/jcm12134554"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"087","DOI":"10.1055\/s-0035-1563381","article-title":"Intraoperative Use of Vasopressors Is Safe in Head and Neck Free Tissue Transfer","volume":"32","author":"Swanson","year":"2015","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.bja.2023.08.026","article-title":"Intraoperative Hypotension and Postoperative Outcomes: A Meta-Analysis of Randomised Trials","volume":"131","author":"Fominskiy","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1002\/lary.20825","article-title":"What Makes a Good Flap Go Bad?: A Critical Analysis of the Literature of Intraoperative Factors Related to Free Flap Failure: Factors Related to Free Flap Failures","volume":"120","author":"Pattani","year":"2010","journal-title":"Laryngoscope"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/hmed.2021.0668","article-title":"Anaesthesia for Reconstructive Free Flap Surgery for Head and Neck Cancer","volume":"83","author":"McCauley","year":"2022","journal-title":"Br. J. Hosp. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1016e","DOI":"10.1097\/PRS.0000000000002176","article-title":"The Effect of Norepinephrine and Dopamine on Radial Forearm Flap Partial Tissue Oxygen Pressure and Microdialysate Metabolite Measurements: A Randomized Controlled Trial","volume":"137","author":"Raittinen","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1097\/PRS.0b013e31825dbf73","article-title":"Epinephrine, Norepinephrine, Dobutamine, and Dopexamine Effects on Free Flap Skin Blood Flow","volume":"130","author":"Eley","year":"2012","journal-title":"Plast. Reconstr. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/24\/7753\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:40:42Z","timestamp":1760132442000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/24\/7753"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,18]]},"references-count":27,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["jcm12247753"],"URL":"https:\/\/doi.org\/10.3390\/jcm12247753","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,18]]}}}