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The perioperative care of adult patients undergoing free tissue transfer during head and neck surgical (microvascular) reconstruction is inconsistent across practitioners and institutions. The executive board of the Society for Head and Neck Anesthesia (SHANA) nominated specialized anesthesiologists and head and neck surgeons to an expert group, to develop expert consensus statements. The group conducted an extensive review of the literature to identify evidence and gaps and to prioritize quality improvement opportunities. This report of expert consensus statements aims to improve and standardize perioperative care in this setting. The Modified Delphi method was used to evaluate the degree of agreement with draft consensus statements. Additional discussion and collaboration was performed via video conference and electronic communication to refine expert opinions and to achieve consensus on key statements. Thirty-one statements were initially formulated, 14 statements met criteria for consensus, 9 were near consensus, and 8 did not reach criteria for consensus. The expert statements reaching consensus described considerations for preoperative assessment and optimization, airway management, perioperative monitoring, fluid management, blood management, tracheal extubation, and postoperative care. This group also examined the role for vasopressors, communication, and other quality improvement efforts. This report provides the priorities and perspectives of a group of clinical experts to help guide perioperative care and provides actionable guidance for and opportunities for improvement in the care of patients undergoing free tissue transfer for head and neck reconstruction. The lack of consensus for some areas likely reflects differing clinical experiences and a limited available evidence base.

Objective The objective of this study was to develop a child-friendly biofeedback mediated relaxation device called “BrightHearts”. Methods Qualitative data were collected at a tertiary pediatric hospital to inform an iterative design process. Clinicians participated in expert group interviews to identify practical considerations which would facilitate the use of BrightHearts during procedures and provide feedback on prototype designs. Children aged 7-18 years participated in interactive exhibitions of the prototypes and were interviewed about their experience using BrightHearts. Results Twenty-four clinicians participated in 6 group interviews. Thirty-nine children participated in interactive exhibitions and 21 were interviewed. Clinicians placed high value on the following factors in the management of procedural pain: providing children with an element of control, the use of relaxation techniques, the use of portable electronic devices such as iPads (Apple Inc Cupertino CA). They highlighted the need for BrightHearts to be cost effective, portable and capable of engaging childrens’ interest. They confirmed the utility of developing a biofeedback assisted relaxation device for children. Based on the factors identified by clinicians BrightHearts was developed as an iPad app paired with a wireless heart rate monitor. The BrightHearts heart rate biofeedback application displays a digital geometric artwork which responds to changes in heart rate. Children aged 7 to 17 years understood the concept of biofeedback and operate the app by slowing their heart rate. Conclusion The BrightHearts app can be used to teach children biofeedback assisted relaxation. Ongoing studies are evaluating its efficacy for the management of procedural pain in children. This article is protected by copyright. All rights reserved.