Comparison of the effects of intravenous and inhalational anesthesia on postoperative pulmonary complications after oral and maxillofacial surgery with free flap reconstruction: a double-blind, randomized, controlled trial

Abstract

Background: The effects of intravenous and inhalation anesthesia on intraoperative and postoperative pulmonary inflammatory responses have been reported in many studies. The differences in clinical postoperative pulmonary complications (PPCs) have been also studied in cardiac and lung resection surgery. However, there are few relevant reports and the findings remain controversial. Clinical evidence for the effects of these two anesthetics on PPCs in other types of surgery is still missing. The main goal of the current study was to assess the impact of sevoflurane and propofol on the incidence of PPCs in patients undergoing oral and maxillofacial surgery. Methods: In this double-blind, randomized, controlled trial, we randomly assigned 220 adults at intermediate-to-high risk of pulmonary complications after oral and maxillofacial cancer surgery with radial forearm or fibular flap reconstruction to either propofol or sevoflurane as a general anesthetic. The occurrence of pulmonary complications according to the Clavien-Dindo score was defined as the primary (within 7 days after surgery) outcome. Results: The two intervention groups had similar characteristics at baseline. The PPCs incidence during 7 days after surgery was 32.4% and 18.2% in the propofol and sevoflurane groups, respectively (adjusted relative risk, 0.44; 95% confidence interval [CI], 0.22 to 0.91; P = 0.027). The corresponding incidence of PPCs in patients who underwent tracheotomy at the end of surgery in the two groups was 44.8% and 24.5% (adjusted relative risk, 0.39; 95% CI, 0.17 to 0.91; P = 0.030). In addition, the Clavien-Dindo classification showed significant differences between groups in minor complications (grade I and II) but not in major complications (grade III to V). Intergroup difference in the time to occurrence of the first PPC after surgery was significant (P = 0.021). There was no difference in postoperative hospital stay between the two groups. Conclusions: Compared with intravenous anesthesia, the administration of sevoflurane reduces the incidence of minor PPCs (grade I to II) in moderate- and high-risk patients who have undergone tracheotomy after oral and maxillofacial cancer surgery with radial forearm or fibular flap reconstruction.