Anaesthesia for patients undergoing prolonged reconstructive and microvascular plastic surgery

The anaesthesiological problems related to prolonged reconstructive plastic surgery in 22 patients were investigated in retrospect. Surgery consisted mainly of reconstructions, including microvascularization (7 emergency reimplantations, 15 plastic reconstructions), and the duration of the balanced anaesthesias varied between 5 h 10 min and 15 h 35 min. As the patients were relatively young and healthy, no serious cardiovascular complications occurred. Blood loss was intentionally replaced with dextran, in most instances, and in a group of 15 elective patients, mean haematocrit level decreased from 0.41 to 0.31 during surgery. In about half of the material, the central temperature was monitored; it remained within 35.8-38 degrees C. In the longest anaesthesia (15 h 35 min) the temperature stayed within 0.4 degrees C, the patient placed on a heating mattress. In 2 patients, transient paresis of the muscles of the hand, which was exposed and abducted for i.v. infusion and blood pressure recording, was observed. A questionnaire was sent to the patients and 19 of 20 responded. The predominant subjective complaint was nausea, while sensations following catheterization of the bladder were also a common untoward recollection. One patient developed laryngeal oedema after extubation and about a third experienced breathing difficulties on awakening from the anaesthesia. Postoperative pain appeared not to be a significant problem.