title: Differences between Total Intravenous Anesthesia and Inhalation Anesthesia in Free Flap Surgery of Head and Neck Cancer.
abstract: BACKGROUND
  Many studies have evaluated risk factors associated with complications after free flap surgery, but these studies did not evaluate the impact of anesthesia management. The goal of the current study was to evaluate the differences between patients who received inhalation and total intravenous anesthesia (TIVA) in free flap surgery.
  
  
  METHODS
  One hundred and fifty-six patients who underwent free flap surgery for head and neck cancer were retrospectively divided into the TIVA (96 patients) and the inhalation group (87 patients). Perioperative hemodynamic data and postoperative medical complications were determined by documented medical records.
  
  
  RESULTS
  Ninety-six patients in the TIVA group were compared with 87 patients who received inhalation anesthesia. There were no differences in gender, age, classification of physical status based on American Society for Anesthesiologists (ASA) score, and cormobidities between the two groups. Patients in the TIVA group required less perioperative crystalloid (4172.46 ± 1534.95 vs. 5183.91 ± 1416.40 ml, p < 0.0001) and colloid (572.46 ± 335.14 vs. 994.25 ± 434.65 ml, p < 0.0001) to maintain hemodynamic stability. Although the mean anesthesia duration was shorter in the TIVA group (11.02 ± 2.84 vs. 11.70± 1.96 hours, p = 0.017), the blood loss was similar between groups (p = 0.71). There was no difference in surgical complication rate, but patients in the TIVA group developed fewer pulmonary complications (18 vs. 47, p = 0.0008). After multivariate regression, patients in the TIVA group had a significantly reduced risk of pulmonary complication compared with the inhalation group (Odds ratio 0.41, 95% CI 0.18-0.92).
  
  
  CONCLUSIONS
  Total intravenous anesthesia was associated with significantly fewer pulmonary complications in patients who received free flap reconstruction.
authors: Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Yi-Ting
authors: YT
authors: Chang
authors: Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Chih-Chen
authors: CC
authors: Wu
authors: Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Tsung-Yung
authors: TY
authors: Tang
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Taichung Veterans General Hospital, Taiwan, ROC.
authors: Chun-Te
authors: CT
authors: Lu
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Taichung Veterans General Hospital, Taiwan, ROC.
authors: Chih-Sheng
authors: CS
authors: Lai
authors: Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Ching-Hui
authors: CH
authors: Shen
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D000769:Anesthesia, Inhalation; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D003131:Combined Modality Therapy; D016208:Databases, Factual; D019468:Disease Management; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous