Abstract: Background and purpose: Perioperative anesthetic management is thought to be critical to the success of free flap breast reconstruction. The purpose of this study was to discuss intraoperative fluid, hemodynamic and temperature management in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods: From Jun. 2011 to Dec. 2015, 126 patients underwent DIEP flap breast reconstruction. Postoperative complications were reviewed. Intraoperative fluid infusion rate was analyzed. Mean arterial blood pressure (MAP) and core temperature were measured before induction (T₀), after flap elevation but before flap transfer (T₁), 15 min after flap revascularization (T₂), and at the end of surgery (T3). Results: Nine patients developed flap compromised: 7 were salvaged and 2 failed. The mean intraoperative fluid infusion rate was (5.44±1.66) (mL•kg^-1)/h. MAP at T₀, T₁, T₂ and T₃ were (87.45±8.90), (74.19±8.63), (74.60±8.71) and (79.62±7.88) mmHg, respectively. Core temperature at T₀, T₁, T₂ and T₃ were (36.69±0.14), (36.36±0.18), (36.27±0.14) and (36.21±0.15) ℃, respectively. Conclusion: Standard practice focusing on intraoperative fluid management, hemodynamic adjustment and temperature control in microsurgical reconstruction of the breast should be established to further improve free flap outcome.

Key words: Breast reconstruction, Free flap, Intraoperative fluid management, Mean arterial blood pressure, Core temperature