Guo Chenyue, Lou Feifei, Wu Jiong, Zhang Jun
Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
JPRAS Open. 2024 Aug 6;42:22-32. doi: 10.1016/j.jpra.2024.07.020. eCollection 2024 Dec.
Microsurgical breast reconstruction after mastectomy is emerging as the standard of care for patients with breast cancer. The enhanced recovery after surgery (ERAS) pathway in abdominal-based free flap breast reconstruction is in its early stage of development and lacks established consensus or guidelines. In the multidisciplinary ERAS team, the anesthesia sub-team is responsible for the provision of several core elements in the ERAS pathway including anesthetic protocol optimization, perioperative fluid management and homeostasis regulation, normothermia maintenance, perioperative analgesia, and postoperative nausea and vomiting prophylaxis. Here, we summarized the state-of-the-art in anesthetic practice for the patients undergoing abdominal-based free flap breast reconstruction within an ERAS framework, and also introduced the perioperative strategy for this surgical population based on the ERAS pathway in our center, aiming to improve free flap outcome and patient satisfaction, and accelerating their recovery following surgery.
乳房切除术后的显微外科乳房重建正逐渐成为乳腺癌患者的护理标准。基于腹部的游离皮瓣乳房重建中的加速康复外科（ERAS）路径尚处于发展初期，缺乏既定的共识或指南。在多学科ERAS团队中，麻醉子团队负责在ERAS路径中提供几个核心要素，包括麻醉方案优化、围手术期液体管理和内环境稳定调节、体温正常维持、围手术期镇痛以及术后恶心和呕吐预防。在此，我们总结了在ERAS框架内接受基于腹部的游离皮瓣乳房重建患者的麻醉实践的最新情况，并介绍了我们中心基于ERAS路径针对该手术人群的围手术期策略，旨在改善游离皮瓣效果和患者满意度，并加速他们术后的康复。
