Differences between Total Intravenous Anesthesia and Inhalation Anesthesia in Free Flap Surgery of Head and Neck Cancer

Chang, Yi Ling; Wu, Chih-Chung; Tang, Tsung-Yung; Lu, Chun-Te; Lai, Chih-Sheng; Shen, Ching-Hui

doi:10.1371/journal.pone.0147713

Cited by 22 publications

(16 citation statements)

References 18 publications

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“…27 Although we excluded patients with a low risk of PPCs and a larger proportion of patients underwent tracheotomy, the observed rate of PPCs in our study was slightly lower than that in the previous study. 2,3,28 This finding may be associated with the improvement in operation time, intravascular volume management, blood loss and transfusion (no patient underwent blood transfusion in this study), etc, which appear to have an important impact on the risk of PPCs during major surgery. 2,29 Thirty-three of the 201 patients in our study had postoperative pneumonia (POP), which is inconsistent with previous reports.…”

Section: Discussionmentioning

confidence: 64%

“…Perforator-based free flaps have been increasingly used in the repair and reconstruction in head and neck surgery. Previous studies have shown that the incidence of PPCs after free flap surgery is 18.8% to 44.8%, 1,2,3 while that of PPCs in patients undergoing head and neck surgery with tracheotomy is up to 47%. 4 It is a key point for anesthesiologists to prevent and reduce the occurrence of PPCs.…”

Section: Introductionmentioning

confidence: 96%

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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

Zhou¹,

Zhu²,

Wang³

et al. 2019

Preprint

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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.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 96%

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

Zhou¹,

Zhu²,

Wang³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…53 Another retrospective study investigated the role of different anesthetic strategy in 156 patients who underwent free flap surgery for head and neck cancer. 54 No differences in hospital mortality or length of stay were observed between groups, probably due also to a little sample. However, patients receiving propofol showed a lower rate of postoperative pulmonary complications, as opposed to those receiving inhalational anesthetics.…”

Section: Current Evidence On the Effects Of Anesthesia On Short And Lmentioning

confidence: 91%

“…However, patients receiving propofol showed a lower rate of postoperative pulmonary complications, as opposed to those receiving inhalational anesthetics. 54 Data from prospective randomized controlled trials are nowadays little. In a small randomized controlled trial, 28 consecutive patients undergoing oncological surgery for urinary bladder cancer were randomized to receive or total intravenous anesthesia or balanced inhalational anesthesia.…”

Section: Current Evidence On the Effects Of Anesthesia On Short And Lmentioning

confidence: 99%

<p>Anesthetic Strategies in Oncological Surgery: Not Only a Simple Sleep, but Also Impact on Immunosuppression and Cancer Recurrence</p>

Longhini¹,

Bruni²,

Garofalo³

et al. 2020

CMAR

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Tumor recurrences or metastases remain a major hurdle in improving overall cancer survival. In the perioperative period, the balance between the ability of the cancer to seed and grow at the metastatic site and the ability of the patient to fight against the tumor (i.e. the host antitumor immunity) may determine the development of clinically evident metastases and influence the patient outcome. Up to 80% of oncological patients receive anesthesia and/or analgesia for diagnostic, therapeutic or palliative interventions. Therefore, anesthesiologists are asked to administer drugs such as opiates and volatile or intravenous anesthetics, which may determine different effects on immunomodulation and cancer recurrence. For instance, some studies suggest that intravenous drugs, such as propofol, may inhibit the host immunity to a lower extent as compared to volatile anesthetics. Similarly, some studies suggest that analgesia assured by local anesthetics may provide a reduction of cancer recurrence rate; whilst on the opposite side, opioids may exert negative consequences in patients undergoing cancer surgery, by interacting with the immune system response via the modulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, or directly through the opioid receptors on the surface of immune cells. In this review, we summarize the main findings on the effects induced by different drugs on immunomodulation and cancer recurrence.

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“…[3] Health professionals and the environmental health community have an obligation to inform, advice, and implement changes to address these concerns. [4] There are many comparisons of total intravenous anesthesia (TIVA) and inhalational agents [5][6][7][8][9] , but studies concerning the consumption of anesthetic agents and cost analysis of use in OLV are limited. The present study aims to evaluate the total quantity of intravenous and inhalational anesthetic agents used during OLV and to discuss the aspect of the cost-effectiveness of these two techniques with respect to the current literature.…”

Section: Introductionmentioning

confidence: 99%

The Consumption of Anesthetic Agents During One-lung Ventilation and a Cost Analysis: a Comparison of Two Techniques

Geyik¹

2019

South Clin Ist Euras

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This prospective, randomized clinical trial aims to compare the direct cost of two anesthetic techniques used in thoracic surgery during one-lung ventilation (OLV). Methods: In this study, adult patients scheduled for thoracic surgery under general anesthesia were randomized to receive either inhalational (deflurane) or total intravenous anesthesia (propofol), with a continuous infusion of remifentanil in both groups. The depth of anesthesia was maintained at a sustained bispectral index value of 40±10. The total quantity of drugs dispensed was estimated, and a cost analysis was performed using hospital pharmacy prices. The patients' demographic information, perioperative characteristics, and recovery time needed to achieve a modified Aldrete score of ≥8 were recorded. Results: In total, 60 patients were enrolled in this study. Patients' demographic details and the duration of anesthesia were comparable between groups. There was no statistically significant difference between the groups with respect to perioperative surgical characteristics. In a 2 L/minute fresh gas flow, the consumption of desflurane was 120.9±75.37 mL. The cost of desflurane-balanced anesthesia was significantly greater than that of propofol (p<0.001) with comparable clinical characteristics. Conclusion: Inhalational-based balanced anesthesia is an important point of consideration from a pharmacoeconomical aspect. Low flow anesthesia studies will be important for costsaving in all general anesthesia applications using inhalational anesthetics, including OLV used during thoracic surgery.

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Differences between Total Intravenous Anesthesia and Inhalation Anesthesia in Free Flap Surgery of Head and Neck Cancer

Cited by 22 publications

References 18 publications

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

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

<p>Anesthetic Strategies in Oncological Surgery: Not Only a Simple Sleep, but Also Impact on Immunosuppression and Cancer Recurrence</p>

The Consumption of Anesthetic Agents During One-lung Ventilation and a Cost Analysis: a Comparison of Two Techniques

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