Department of Anesthesiology, Peking University Third Hospital, Beijing, China.
Department of Intensive Care Medicine, Peking University Third Hospital, Beijing, China.
Laryngoscope. 2021 Jan;131(1):E108-E115. doi: 10.1002/lary.28724. Epub 2020 May 5.
OBJECTIVES/HYPOTHESIS: The differences between intravenous and inhalation anesthesia in clinical postoperative pulmonary complications (PPCs) have been studied in cardiac and lung resection surgery. Clinical evidence for the effects of these two anesthetics on PPCs in other types of surgery is still missing. We aimed to assess the impact of sevoflurane and propofol on the incidence of PPCs in patients undergoing surgery for head and neck cancer.
Double-blind, randomized, controlled trial.
We assigned 220 adults at intermediate-to-high risk of PPCs scheduled for head and neck 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.
The PPC incidence during 7 days after surgery was 32.4% and 18.2% in the propofol and sevoflurane groups, respectively (P = .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%, respectively (P = .030). In addition, the Clavien-Dindo classification showed significant differences between groups in minor complications (grades I and II) but not in major complications (grades III-V).
Compared with intravenous anesthesia, the administration of sevoflurane reduces the incidence of minor PPCs (grades I and II) in moderate- and high-risk patients who have undergone tracheotomy after head and neck cancer surgery with radial forearm or fibular flap reconstruction.
2 Laryngoscope, 131:E108-E115, 2021.
目的/假设：静脉麻醉和吸入麻醉在心脏和肺切除术的临床术后肺部并发症（PPCs）中的差异已被研究。关于这两种麻醉剂对其他类型手术 PPCs 的影响的临床证据仍然缺乏。我们旨在评估七氟醚和丙泊酚对接受头颈部癌症手术的患者 PPCs 发生率的影响。
双盲、随机、对照试验。
我们将 220 名处于中高危 PPCs 风险的接受头颈部癌症手术并进行桡骨或腓骨皮瓣重建的成年人随机分为丙泊酚或七氟醚全身麻醉组。根据 Clavien-Dindo 评分定义肺部并发症的发生（术后 7 天内）为主要（术后）结局。
术后 7 天内 PPC 的发生率分别为丙泊酚组 32.4%和七氟醚组 18.2%（P =.027）。两组在手术结束时行气管切开术的患者的 PPC 发生率分别为 44.8%和 24.5%（P =.030）。此外，Clavien-Dindo 分类显示组间在轻微并发症（I 级和 II 级）但在主要并发症（III-V 级）方面存在显著差异。
与静脉麻醉相比，七氟醚的给药可降低中高危患者头颈部癌症手术和桡骨或腓骨皮瓣重建后行气管切开术的患者的轻微 PPCs（I 级和 II 级）发生率。
2 级喉镜，131：E108-E115，2021 年。
