• Helene Retrouvey, Jacqueline R Makerewich, Ogi Solaja, Anthony M Giuliano, Ahtsham U Niazi, and Heather L Baltzer.
• Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto Western Hand Program, Toronto, Ontario, Canada.
• Microsurgery. 2020 Jan 1; 40 (1): 5-11.

PurposeDespite the common use of intraoperative vasopressors in hand microsurgery, the association between intraoperative vasopressor use and digital replant failure has not yet been examined. Our study aims to examine the association between intraoperative vasopressor use (phenylephrine and/or ephedrine) and postoperative digital failure of replanted or revascularized digits.MethodsAll patients from a single tertiary hand center who underwent unilateral digital replantation or revascularization procedures between 2005 and 2016 were included in this retrospective cohort study. The relationship between intraoperative vasopressors used to maintain hemodynamic stability and digit failure was then evaluated using logistic regression. Specifically, phenylephrine (total dose 10-3,600 mcg) and ephedrine (5-110 mg) use were evaluated.ResultsDuring the study period, 281 patients underwent digital replantation or revascularization. Of those, 86 (31%) were given an intraoperative vasopressor. Digit failure was more likely in patients with crush or avulsion injuries compared to clean-cut mechanism (odds ratio [OR] 2.02, p = .02), and in patients with replantation (OR 7.85, p < .0001) as compared to revascularization procedures. Using multivariate logistic regression adjusting for age, sex, smoking status, comorbidities, number of digits injured, injury type, and procedure type, the odds of digital failure with vasopressor use were not increased (p = .84). When evaluating vasopressors used after tourniquet deflation, failure increased with ephedrine use (OR = 2.42, p = .0496) and phenylephrine use (OR = 2.21, p = .31).ConclusionsThe use of vasopressors was not associated with failure if administration of vasopressors was before tourniquet deflation. The administration of vasopressors after tourniquet deflation should be cautioned.© 2019 Wiley Periodicals, Inc.

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