理解的对吗？谢谢

Opioids given during DIEP flap surgery increase shivering, PONV, and pain, which might induce flap loss. Patients undergoing OFA for DIEP flap require less or no opioids postoperatively, making recovery very smooth without shivering, nausea, or pain. Peripheral vasodilation increases cardiac output and a reduced stress during awakening might improve flap perfusion if perfusion pressure is kept elevated. The required total dose of dexmedetomidine for 8 h during a bilateral procedure is only around 1 and 1.6 mg/kg lean body weight (LBW). At this dose, there is no risk of a prolonged sedation and hypotension at the end of anesthesia. Dexmedetomidine is therefore combined with lidocaine (1 mg/kg LBW/h), and 50 mg ketamine before incision and continued intraoperative at 0.1 mg/kg LBW/h) and magnesium at 10 mg/kg LBW/h as described previously for bariatric surgery [32 &]. Postoperative analgesia is possible without opioids.

在DIEP皮瓣手术期间给予阿片类药物会增加颤抖、PONV和疼痛，这可能会导致皮瓣受损。OFA治疗DIEP皮瓣的患者术后较少需要或不需要阿片类药物，使恢复非常顺利，无颤抖、恶心或疼痛。觉醒期间应激降低、外周血管舒张致心输出量增加，若引起灌注压升高，可能改善皮瓣灌注。双侧手术期间右美托咪定8h所需总剂量仅约为1-1.6 ug/kg瘦体重(LBW)。在该剂量下，麻醉结束时无镇静时间延长和低血压风险。因此，如前所述，右美托咪定与利多卡因(1 ug/kg LBW/h)、50 mg氯胺酮（切开前，以0.1 ug/kg LBW/h术中继续给药）和10 ug/kg LBW/h镁联合用于减肥手术。术后镇痛不使用阿片类药物是可能的。