Seeing White: Management of TIVA during autologous breast reconstruction

Piranavhan Vigneswaran; Rachel Clancy; S Y Choo; Sarah Love-Jones; Philippa C Jackson; Sherif M Wilson

doi:10.1016/j.bjps.2021.03.048

Seeing White: Management of TIVA during autologous breast reconstruction

J Plast Reconstr Aesthet Surg. 2021 Sep;74(9):2392-2442. doi: 10.1016/j.bjps.2021.03.048. Epub 2021 Apr 1.

Authors

Piranavhan Vigneswaran¹, Rachel Clancy², S Y Choo², Sarah Love-Jones², Philippa C Jackson², Sherif M Wilson²

Affiliations

¹ Department of Plastic Surgery, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB. Electronic address: pvigneswaran@nhs.net.
² Department of Plastic Surgery, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB.

PMID: 33895092
DOI: 10.1016/j.bjps.2021.03.048

Abstract

Total IntraVenous Anaesthesia is frequently the anaesthetic of choice for enhanced recovery after surgery pathways during breast reconstruction free flap surgery. This relies upon the continuous intravenous infusion of propofol. We describe our experience of two patients where augmentation of a venously congested DIEP flap with a cephalic vein transposition procedure, risked interruption of the intravenous delivery of anaesthesia to the patient. We also share our steps taken to mitigate this risk going forward.

Keywords: Cephalic turndown; DIEP; Enhanced recovery; Propofol; TIVA.

Publication types

Letter

MeSH terms

Anesthesia, Intravenous*
Epigastric Arteries
Free Tissue Flaps / blood supply*
Humans
Mammaplasty / methods*