• Dan Zhou, Xi Zhu, Likuan Wang, Xudong Yang, Yun Liu, and Xiang Zhang.
• Department of Anesthesiology, Peking University Third Hospital, Beijing, China.
• Laryngoscope. 2021 Jan 1; 131 (1): E108-E115.

Objectives/HypothesisThe 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.Study DesignDouble-blind, randomized, controlled trial.MethodsWe 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.ResultsThe 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).ConclusionsCompared 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.Level Of Evidence2 Laryngoscope, 131:E108-E115, 2021.© 2020 The American Laryngological, Rhinological and Otological Society, Inc.

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