Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer.

Mountziaris, Paschalia M; Rudolph, Christina M; Fournier, Craig T; Haykal, Siba; Ricci, Joseph A; Rezak, Kristen M; Patel, Ashit

Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer.

dc.contributor.author	Mountziaris, Paschalia M
dc.contributor.author	Rudolph, Christina M
dc.contributor.author	Fournier, Craig T
dc.contributor.author	Haykal, Siba
dc.contributor.author	Ricci, Joseph A
dc.contributor.author	Rezak, Kristen M
dc.contributor.author	Patel, Ashit
dc.date.accessioned	2023-09-01T16:14:48Z
dc.date.available	2023-09-01T16:14:48Z
dc.date.issued	2022-08
dc.date.updated	2023-09-01T16:14:48Z
dc.description.abstract	Background Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer and to use it to develop evidence-based care guidelines. Methods A systematic review was conducted in the PubMed, Embase, Scopus, and Cochrane Library databases. Because a preliminary search of the pediatric microsurgical literature yielded scant data with a low level of evidence, pediatric anesthesia guidelines for healthy children undergoing major operations were also included. Exclusion criteria included vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children. Results Two hundred four articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High-quality data were found for anesthesia, analgesia, fluid administration/blood transfusion, and anticoagulation (Level I Evidence). Lower quality evidence was identified for patient temperature (Level III Evidence) and vasodilator use (Level IV Evidence). Key recommendations include administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin level is less than 7 g/dl unless the patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high-risk patients. Conclusions Pediatric-specific guidelines are important, as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.
dc.identifier	00006534-202208000-00035
dc.identifier.issn	0032-1052
dc.identifier.issn	1529-4242
dc.identifier.uri	https://hdl.handle.net/10161/28933
dc.language	eng
dc.publisher	Ovid Technologies (Wolters Kluwer Health)
dc.relation.ispartof	Plastic and reconstructive surgery
dc.relation.isversionof	10.1097/prs.0000000000009325
dc.subject	Humans
dc.subject	Blood Transfusion
dc.subject	Perioperative Care
dc.subject	Anesthesia, General
dc.subject	Surgery, Plastic
dc.subject	Adult
dc.subject	Child
dc.subject	Plastic Surgery Procedures
dc.title	Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer.
dc.type	Journal article
duke.contributor.orcid	Rezak, Kristen M\|0000-0001-7626-5732
duke.contributor.orcid	Patel, Ashit\|0000-0002-8384-190X
pubs.begin-page	406e
pubs.end-page	415e
pubs.issue	2
pubs.organisational-group	Duke
pubs.organisational-group	School of Medicine
pubs.organisational-group	Clinical Science Departments
pubs.organisational-group	Surgery
pubs.organisational-group	Surgery, Plastic, Maxillofacial, and Oral Surgery
pubs.publication-status	Published
pubs.volume	150