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

Background: The effects of intravenous and inhalation anesthesia on intraoperative and postoperative pulmonary inflammatory responses have been reported in many studies. However, the differences in clinical postoperative pulmonary complications (PPCs) have rarely been studied, except in cases of lung resection. 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 surgery 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 after surgery was 44.8% and 24.5% (adjusted relative risk, 0.39; 95% CI, 0.17 to 0.91; P = 0.030). 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 frequency of PPCs in intermediate-risk and high-risk patients undergoing oral and maxillofacial surgery with microvascular reconstruction. Trial registration: Clinical Trail Registration: ChiCTR1800015347; Registered March 25, 2018.