Browsing by Author "Mahauri, Insana"

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    Novel Challenges and Opportunities for Anesthesia and Perioperative Care in Microvascular Flap Surgery : A Narrative Review
    (2024-10-18) Ojuva, Aleksi Matias; Rocans, Rihards Peteris; Zariņš, Jānis; Bine, Evita; Mahauri, Insana; Doniņa, Simona; Mamaja, Biruta; Vanags, Indulis; Department of Anaesthesiology, Intensive Care and Clinical simulations; Institute of Microbiology and Virology
    Complex microvascular techniques and in-depth knowledge of blood rheology and microanastomosis function are required for success in microvascular flap surgery. Substantial progress has been achieved in preventing complications, but the rate of flap loss is still significant and can have significant adverse effects on the patient. Flap thrombosis, flap hematoma, and flap loss are the most frequent and severe major surgical complications. Advances in understanding the pathophysiology of different flap complications, the use of preoperative risk assessment and new treatment concepts could improve the perioperative care of microvascular flap surgery patients. Our aim was to outline novel avenues for best practice and provide an outlook for further research of anesthesia and perioperative care concepts in microvascular flap surgery
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    Von Willebrand Factor Antigen, Biomarkers of Inflammation, and Microvascular Flap Thrombosis in Reconstructive Surgery
    (2024-09-12) Rocans, Rihards Peteris; Zarins, Janis; Bine, Evita; Mahauri, Insana; Deksnis, Renars; Citovica, Margarita; Donina, Simona; Vanags, Indulis; Gravelsina, Sabine; Vilmane, Anda; Rasa-Dzelzkaleja, Santa; Mamaja, Biruta; Department of Anaesthesiology, Intensive Care and Clinical simulations; Institute of Microbiology and Virology
    Background: Microvascular flap surgery has become a routine option for defect correction. The role of von Willebrand factor antigen (VWF:Ag) in the pathophysiology of flap complications is not fully understood. We aim to investigate the predictive value of VWF:Ag for microvascular flap complications and explore the relationship between chronic inflammation and VWF:Ag. Methods: This prospective cohort study included 88 adult patients undergoing elective microvascular flap surgery. Preoperative blood draws were collected on the day of surgery before initiation of crystalloids. The plasma concentration of VWF:Ag as well as albumin, neutrophil-to-lymphocyte ratio (NLR), interleukin-6, and fibrinogen were determined. Results: The overall complication rate was 27.3%, and true flap loss occurred in 11.4%. VWF:Ag levels were higher in true flap loss when compared to patients without complications (217.94 IU/dL [137.27–298.45] vs. 114.14 [95.67–132.71], p = 0.001). Regression analysis revealed the association between VWF:Ag and true flap loss at the cutoff of 163.73 IU/dL (OR 70.22 [10.74–485.28], p = 0.043). Increased VWF:Ag concentrations were linked to increases in plasma fibrinogen (p < 0.001), C-reactive protein (p < 0.001), interleukin-6 (p = 0.032), and NLR (p = 0.019). Conclusions: Preoperative plasma VWF:Ag concentration is linked to biomarkers of inflammation and may be valuable in predicting complications in microvascular flap surgery.