Opioid-Free Anaesthesia Reduces Complications in Head and Neck Microvascular Free-Flap Reconstruction
Abstract
:1. Introduction
2. Material and Methods
2.1. Anaesthesia Management Strategy
2.2. Surgical Data and Outcomes
2.3. Statistical Methods
3. Results
3.1. Type of Surgery
3.2. Patient Demographics
3.3. Postoperative Complications
3.4. Blood Loss
3.5. Fluid Management and Net Fluid Balance
3.6. Sympathomimetic Drugs
3.7. Postoperative Invasive Mechanical Ventilation
3.8. Pain and Analgesia
3.9. Length of Stay in the ICU and Duration of Hospitalization
3.10. Other Factors
3.11. Multivariate Analysis
4. Discussion
4.1. Ventilation and Airway Patency
4.2. Pain and Adverse Effects from Analgesics
4.3. Blood Loss and Transfusion
4.4. Fluid Administration and Fluid Losses
4.5. Sympathomimetic Drugs
4.6. Controlled Hypotension, MMOD, and OFA
4.7. AAS, Heparin, and TNX
4.8. Comorbidities
4.9. Paradigm Shift in Surgical-Related Complications
4.10. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- O’Connell, D.A.; Barber, B.; Klein, M.F.; Soparlo, J.; Al-Marzouki, H.; Harris, J.R.; Seikaly, H. Algorithm based patient care protocol to optimize patient care and inpatient stay in head and neck free flap patients. J. Otolaryngol. Head Neck Surg. 2015, 44, 45. [Google Scholar] [CrossRef] [PubMed]
- Healy, D.W.; Cloyd, B.H.; Straker, T.; Brenner, M.J.; Damrose, E.J.; Spector, M.E.; Saxena, A.; Atkins, J.H.; Ramamurthi, R.J.; Mehta, A.; et al. Expert Consensus Statement on the Perioperative Management of Adult Patients Undergoing Head and Neck Surgery and Free Tissue Reconstruction from the Society for Head and Neck Anesthesia. Anesth. Analg. 2021, 133, 274–283. [Google Scholar] [CrossRef] [PubMed]
- Chaukar, D.A.; Deshmukh, A.D.; Majeed, T.; Chaturvedi, P.; Pai, P.; D′cruz, A.K. Factors affecting wound complications in head and neck surgery: A prospective study. Indian J. Med. Paediatr. Oncol. 2013, 34, 247–251. [Google Scholar] [CrossRef] [PubMed]
- Bertelsen, C.; Hur, K.; Nurimba, M.; Choi, J.; Acevedo, J.R.; Jackanich, A.; Sinha, U.K.; Kochhar, A.; Kokot, N.; Swanson, M. Enhanced Recovery After Surgery–Based Perioperative Protocol for Head and Neck Free Flap Reconstruction. OTO Open 2020, 4, 2473974X20931037. [Google Scholar] [CrossRef] [PubMed]
- Chang, Y.-T.; Lai, C.-S.; Lu, C.-T.; Wu, C.-Y.; Shen, C.-H. Effect of Total Intravenous Anesthesia on Postoperative Pulmonary Complications in Patients Undergoing Microvascular Reconstruction for Head and Neck Cancer: A Randomized Clinical Trial. JAMA Otolaryngol. Head Neck Surg. 2022, 148, 1013–1021. [Google Scholar] [CrossRef]
- Hand, W.R.; McSwain, J.R.; McEvoy, M.D.; Wolf, B.; Algendy, A.A.; Parks, M.D.; Murray, J.L.; Reeves, S.T. Characteristics and Intraoperative Treatments Associated with Head and Neck Free Tissue Transfer Complications and Failures. Otolaryngol. Head Neck Surg. 2015, 152, 480–487. [Google Scholar] [CrossRef] [PubMed]
- Dort, J.C.; Farwell, D.G.; Findlay, M.; Huber, G.F.; Kerr, P.; Shea-Budgell, M.A.; Simon, C.; Uppington, J.; Zygun, D.; Ljungqvist, O.; et al. Optimal Perioperative Care in Major Head and Neck Cancer Surgery with Free Flap Reconstruction: A Consensus Review and Recommendations from the Enhanced Recovery After Surgery Society. JAMA Otolaryngol. Head Neck Surg. 2017, 143, 292. [Google Scholar] [CrossRef]
- Jones, N.F.; Jarrahy, R.; Song, J.I.; Kaufman, M.R.; Markowitz, B. Postoperative Medical Complications—Not Microsurgical Complications???-Negatively Influence the Morbidity, Mortality, and True Costs after Microsurgical Reconstruction for Head and Neck Cancer. Plast. Reconstr. Surg. 2007, 119, 2053–2060. [Google Scholar] [CrossRef]
- Zheng, G.; Liu, J.; Yu, P. Intraoperative Fluid Management Implies Insignificant Influence to Surgical Outcomes in Head and Neck Microvascular Reconstruction Cases. Plast. Reconstr. Surg. 2021, 147, 627–633. [Google Scholar] [CrossRef]
- Wong, A.K.; Joanna Nguyen, T.; Peric, M.; Shahabi, A.; Vidar, E.N.; Hwang, B.H.; Niknam Leilabadi, S.; Chan, L.S.; Urata, M.M. Analysis of risk factors associated with microvascular free flap failure using a multi-institutional database: Risk Factors for Free Flap Failure. Microsurgery 2015, 35, 6–12. [Google Scholar] [CrossRef]
- Brown, E.N.; Pavone, K.J.; Naranjo, M. Multimodal General Anesthesia: Theory and Practice. Anesth. Analg. 2018, 127, 1246–1258. [Google Scholar] [CrossRef] [PubMed]
- Vu, C.N.; Lewis, C.M.; Bailard, N.S.; Kapoor, R.; Rubin, M.L.; Zheng, G. Association Between Multimodal Analgesia Administration and Perioperative Opioid Requirements in Patients Undergoing Head and Neck Surgery with Free Flap Reconstruction. JAMA Otolaryngol. Head Neck Surg. 2020, 146, 708. [Google Scholar] [CrossRef] [PubMed]
- Cuomo, A.; Bimonte, S.; Forte, C.A.; Botti, G.; Cascella, M. Multimodal approaches and tailored therapies for pain management: The trolley analgesic model. J. Pain Res. 2019, 12, 711–714. [Google Scholar] [CrossRef] [PubMed]
- Goswami, U.; Jain, A. Anaesthetic implications of free-flap microvascular surgery for head and neck malignancies—A relook. J Anaesthesiol. Clin. Pharmacol. 2021, 37, 499. [Google Scholar] [CrossRef] [PubMed]
- Lauretta, M.P.; Caporali, L.; Manera, S.; Prucher, G.M.; Melotti, R.M. Anaesthetic Challenging in Microsurgical Flap Reconstruction: A Systematic Review. J. Anesth. Clin. Res. 2018, 9, 2. [Google Scholar] [CrossRef]
- Sayal, N.R.; Militsakh, O.; Aurit, S.; Hufnagle, J.; Hubble, L.; Lydiatt, W.; Lydiatt, D.; Lindau, R.; Coughlin, A.; Osmolak, A.; et al. Association of multimodal analgesia with perioperative safety and opioid use following head and neck microvascular reconstruction. Head Neck 2020, 42, 2887–2895. [Google Scholar] [CrossRef] [PubMed]
- Cuschieri, S. The STROBE guidelines. Saudi J. Anaesth. 2019, 13, 31. [Google Scholar] [CrossRef]
- Jaramillo, S.; Montane-Muntane, M.; Gambus, P.L.; Capitan, D.; Navarro-Ripoll, R.; Blasi, A. Perioperative blood loss: Estimation of blood volume loss or haemoglobin mass loss? Blood Transfus. 2020, 18, 20–29. [Google Scholar] [CrossRef]
- Clavien, P.; Sanabria, J.; Strasberg, S. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992, 111, 518–526. [Google Scholar]
- Saçak, B.; Akdeniz, Z.D.; Certel, F.; Kocaaslan, F.N.D.; Tuncer, B.; Çelebiler, Ö. Risk Assessment for Free Tissue Transfers: Is Old Age a Determining Factor? J. Craniofac. Surg. 2015, 26, 856–859. [Google Scholar] [CrossRef]
- Chang, E.I.; Chang, E.I.; Soto-Miranda, M.A.; Zhang, H.; Nosrati, N.; Crosby, M.A.; Reece, G.P.; Robb, G.L.; Chang, D.W. Comprehensive Evaluation of Risk Factors and Management of Impending Flap Loss in 2138 Breast Free Flaps. Ann. Plast. Surg. 2016, 77, 67–71. [Google Scholar] [CrossRef] [PubMed]
- Frederick, J.W.; Sweeny, L.; Carroll, W.R.; Peters, G.E.; Rosenthal, E.L. Outcomes in head and neck reconstruction by surgical site and donor site. Laryngoscope 2013, 123, 1612–1617. [Google Scholar] [CrossRef] [PubMed]
- Naik, A.N.; Freeman, T.; Li, M.M.; Marshall, S.; Tamaki, A.; Ozer, E.; Agrawal, A.; Kang, S.Y.; Old, M.O.; Seim, N.B. The Use of Vasopressor Agents in Free Tissue Transfer for Head and Neck Reconstruction: Current Trends and Review of the Literature. Front. Pharmacol. 2020, 11, 1248. [Google Scholar] [CrossRef] [PubMed]
- Harris, L.; Goldstein, D.; Hofer, S.; Gilbert, R. Impact of vasopressors on outcomes in head and neck free tissue transfer. Microsurgery 2012, 32, 15–19. [Google Scholar] [CrossRef] [PubMed]
- Sweeny, L.; Rosenthal, E.L.; Light, T.; Grayson, J.; Petrisor, D.; Troob, S.H.; Greene, B.J.; Carroll, W.R.; Wax, M.K. Outcomes and cost implications of microvascular reconstructions of the head and neck. Head Neck 2019, 41, 930–939. [Google Scholar] [CrossRef] [PubMed]
- Yu, P.K.; Sethi, R.K.V.; Rathi, V.; Puram, S.V.; Lin, D.T.; Emerick, K.S.; Durand, M.L.; Deschler, D.G. Postoperative care in an intermediate-level medical unit after head and neck microvascular free flap reconstruction: Intermediate Care Unit after Free Flap. Laryngoscope Investig. Otolaryngol. 2019, 4, 39–42. [Google Scholar] [CrossRef] [PubMed]
- Alsubaie, H.M.; Abu-Zaid, A.; Sayed, S.I.; Pathak, K.A.; Almayouf, M.A.; Albarrak, M.; Aldhahri, S.F.; Al-Qahtani, K.H. Tranexamic acid in head and neck procedures: A systematic review and meta-analysis of randomized controlled trials. Eur. Arch. Oto-Rhino-Laryngol. 2022, 279, 2231–2238. [Google Scholar] [CrossRef]
- Ali, M.; Dort, J.C.; Sauro, K.M. Preoperative hemoglobin and perioperative blood transfusion in major head and neck surgery: A systematic review and meta-analysis. J. Otolaryngol. Head Neck Surg. 2023, 52, 3. [Google Scholar] [CrossRef]
- Myles, P.S.; Bellomo, R.; Corcoran, T.; Forbes, A.; Peyton, P.; Story, D.; Christophi, C.; Leslie, K.; McGuinness, S.; Parke, R.; et al. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N. Engl. J. Med. 2018, 378, 2263–2274. [Google Scholar] [CrossRef]
- Burkhard, J.-P.; Pfister, J.; Giger, R.; Huber, M.; Lädrach, C.; Waser, M.; Olariu, R.; Engel, D.; Löffel, L.M.; Schaller, B.; et al. Perioperative predictors of early surgical revision and flap-related complications after microvascular free tissue transfer in head and neck reconstructions: A retrospective observational series. Clin. Oral Investig. 2021, 25, 5541–5550. [Google Scholar] [CrossRef]
- Kass, J.L.; Lakha, S.; Levin, M.A.; Joseph, T.; Lin, H.-M.; Genden, E.M.; Teng, M.S.; Miles, B.A.; DeMaria Jr, S. Intraoperative hypotension and flap loss in free tissue transfer surgery of the head and neck. Head Neck 2018, 40, 2334–2339. [Google Scholar] [CrossRef]
- Abouyared, M.; Katz, A.P.; Ein, L.; Ketner, J.; Sargi, Z.; Nicolli, E.; Leibowitz, J.M. Controversies in free tissue transfer for head and neck cancer: A review of the literature. Head Neck 2019, 41, 3457–3463. [Google Scholar] [CrossRef]
- Chierichini, A.; Rossi, M. Anesthesia and Perioperative Care in Cervical Spinal Surgery. In Cervical Spine: Minimally Invasive and Open Surgery; Menchetti, P.P.M., Ed.; Springer International Publishing: Cham, Switzerland, 2022; pp. 63–81. ISBN 978-3-030-94829-0. [Google Scholar]
- Hajibandeh, S.; Hajibandeh, S.; Bill, V.; Satyadas, T. Meta-analysis of Enhanced Recovery After Surgery (ERAS) Protocols in Emergency Abdominal Surgery. World J. Surg. 2020, 44, 1336–1348. [Google Scholar] [CrossRef]
- Stulberg, J.J.; Huang, R.; Kreutzer, L.; Ban, K.; Champagne, B.J.; Steele, S.R.; Johnson, J.K.; Holl, J.L.; Greenberg, C.C.; Bilimoria, K.Y. Association Between Surgeon Technical Skills and Patient Outcomes. JAMA Surg. 2020, 155, 960–968. [Google Scholar] [CrossRef]
N | Integrated | Small Defects | Dehiscence | Partial Necrosis | Loss of Flap | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Donor Site: AL Thigh | 15 | 8 | (53.3%) | 3 | (20%) | 3 | (20%) | 1 | (6.7%) | ||
Cancer Extirpation | 15 | 8 | (53.3%) | 3 | (20%) | 3 | (20%) | 1 | (6.7%) | ||
Neck Dissection | 15 | 8 | (53.3%) | 3 | (20%) | 3 | (20%) | 1 | (6.7%) | ||
Prior Surgery | 4 | 1 | (25%) | 2 | (50%) | ||||||
Radiation Exposure | 3 | 1 | (33.3%) | 1 | (33.3%) | ||||||
Donor Site: Forearm | 26 | 19 | (73.1%) | 2 | (7.7%) | 4 | (15.4%) | 1 | (3.8%) | ||
Cancer Extirpation | 26 | 19 | (73.1%) | 2 | (7.7%) | 4 | (15.4%) | 1 | (3.8%) | ||
Neck Dissection | 19 | 13 | (68.4%) | 2 | (10.5%) | 3 | (15.8%) | 1 | (5.3%) | ||
Prior Surgery | 11 | 6 | (54.5%) | 2 | (18.2%) | 1 | (9.1%) | ||||
Radiation Exposure | 2 | 2 | (100%) | ||||||||
Donor Site: Iliac Crest | 17 | 10 | (58.8%) | 2 | (11.8%) | 2 | (11.8%) | 2 | (11.8%) | 1 | (5.9%) |
Cancer Extirpation | 14 | 10 | (71.4%) | 1 | (7.1%) | 2 | (14.3%) | 1 | (7.1%) | ||
Neck Dissection | 5 | 4 | (80%) | 1 | (20%) | ||||||
Prior Surgery | 6 | 1 | (16.7%) | 2 | (33.3%) | 2 | (33.3%) | 1 | (16.7%) | ||
Radiation Exposure | 4 | 1 | (25%) | 2 | (50%) | 1 | (25%) | ||||
Donor Site: Fibula | 39 | 11 | (28.2%) | 14 | (35.9%) | 6 | (15.4%) | 3 | (7.7%) | 5 | (12.8%) |
Cancer Extirpation | 20 | 7 | (35%) | 5 | (25%) | 6 | (30%) | 2 | (10%) | ||
Neck Dissection | 11 | 4 | (36.4%) | 2 | (18.2%) | 3 | (27.3%) | 2 | (18.2%) | ||
Prior Surgery | 25 | 6 | (24%) | 9 | (36%) | 3 | (12%) | 2 | (8%) | 5 | (20%) |
Radiation Exposure | 21 | 7 | (33.3%) | 6 | (28.6%) | 1 | (4.8%) | 2 | (9.5%) | 5 | (23.8%) |
Donor Site: Other | 10 | 5 | (50%) | 2 | (20%) | 1 | (10%) | 2 | (20%) | ||
Cancer Extirpation | 8 | 4 | (50%) | 2 | (25%) | 1 | (12.5%) | 1 | (12.5%) | ||
Neck Dissection | 6 | 3 | (50%) | 1 | (16.7%) | 1 | (16.7%) | 1 | (16.7%) | ||
Prior Surgery | 3 | 2 | (66.7%) | 1 | (33.3%) | ||||||
Radiation Exposure | 2 | 1 | (50%) | 1 | (50%) | ||||||
TOTAL | 107 | 53 | 49.5% | 20 | 18.7% | 12 | 11.2% | 12 | 11.2% | 10 | 9.3% |
Excluded Variables | Included in the Equation |
---|---|
Overall complications | Comorbidities*, Sex (cat), Age, BMI, ASA ≥ 3 Sympathomimetics in the OR OFA (OR 0.30, CI 95% 0.04–0.89, p = 0.011) (cat), Fluid administered (mL), Blood loss reported (mL), Transfusion in Radionecrosis (OR 5.3, CI 95% 1.12–25.41, p = 0.035) OR (cat), RBC transfused in OR (N Units), FTT Donor-Site |
Flap loss | OFA, Comorbidities*, Sex (cat), Age, BMI, Sympathomimetics in the OR BMI (OR 0.76, CI 95%, 0.582–0.995) (cat), Fluid administered (mL), Blood loss reported (mL), Transfusion in Radionecrosis (OR 4.63, CI 95% 0.97–21.95) OR (cat), RBC transfused in OR (N Units), FTT Donor-Site ASA status ≥ 3 (OR 11.77, CI 95% 1.76–78.82) |
*Comorbidities | Preoperative INR value, Preoperative platelet count, and Preoperative Hb concentration, as continuous variables. Binomial categories were considered for: Hypertension, Cardiac Insufficiency, Vascular Disease, Diabetes Mellitus type 2, Hiperlipidaemia, Respiratory Disease, History of different neoplasm, Chronic Pain, Depression, Alcohol consumption, Tobacco use, Anticoagulation therapy, Sedative use, and Opioid use. |
N | Complications | Flap Loss | Surgery Duration | REMI | MMOD | OFA | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Oral Cancer | 48 | 33 | (68.8%) | 3 | (6.3%) | 9H 45′ | (585′) | 26 | (54.2%) | 22 | (45.8%) | 16 | (33.3%) |
Anterolateral Thigh | 13 | 9 | (69.2%) | 1 | (7.7%) | 9H 52′ | (592′) | 10 | (76.9%) | 3 | (23.1%) | 2 | (15.4%) |
Forearm | 20 | 11 | (55%) | 1 | (5%) | 9H 10′ | (550′) | 12 | (60%) | 8 | (40%) | 4 | (20%) |
Iliac Crest | 1 | 0 | (0%) | 0 | (0%) | 7H 45′ | (465′) | 0 | (0%) | 1 | (100%) | 1 | (100%) |
Fibula | 9 | 8 | (88.9%) | 0 | (0%) | 11H 12′ | (672′) | 3 | (33.3%) | 6 | (66.7%) | 6 | (66.7%) |
Other | 5 | 5 | (100%) | 1 | (20%) | 9H 32′ | (572′) | 1 | (20%) | 4 | (80%) | 3 | (60%) |
RadioNecrose | 20 | * 18 | (90%) | * 6 | (30%) | 9H 39′ | (579′) | 11 | (55%) | 9 | (45%) | 5 | (25%) |
Iliac Crest | 3 | 3 | (100%) | 0 | (0%) | 8H 21′ | (501′) | 1 | (33.3%) | 2 | (66.7%) | 1 | (33.3%) |
Fibula | 16 | 14 | (87.5%) | 5 | (31.3%) | 9H 56′ | (596′) | 9 | (56.3%) | 7 | (43.8%) | 4 | (25%) |
Other | 1 | 1 | (100%) | 1 | (100%) | 9H 7′ | (547′) | 1 | (100%) | 0 | (0%) | 0 | (0%) |
Face-Skin Cancer | 9 | 4 | (44.4%) | 0 | (0%) | 7H 35′ | (455′) | 6 | (66.7%) | 3 | (33.3%) | 3 | (33.3%) |
Anterolateral Thigh | 1 | 0 | (0%) | 0 | (0%) | 8H 3′ | (483′) | 0 | (0%) | 1 | (100%) | 1 | (100%) |
Antebraquial | 6 | 3 | (50%) | 0 | (0%) | 7H 25′ | (445′) | 5 | (83.3%) | 1 | (16.7%) | 1 | (16.7%) |
Other | 2 | 1 | (50%) | 0 | (0%) | 7H 51′ | (471′) | 1 | (50%) | 1 | (50%) | 1 | (50%) |
Maxilar Cancer | 13 | 8 | (61.5%) | 0 | (0%) | 9H 50′ | (590′) | 5 | (38.5%) | 8 | (61.5%) | 4 | (30.8%) |
Anterolateral Thigh | 1 | 0 | (0%) | 0 | (0%) | 8H 20′ | (500′) | 0 | (0%) | 1 | (100%) | 1 | (100%) |
Iliac Crest | 5 | 4 | (80%) | 0 | (0%) | 10H 18′ | (618′) | 2 | (40%) | 3 | (60%) | 2 | (40%) |
Fibula | 7 | 4 | (57.1%) | 0 | (0%) | 9H 44′ | (584′) | 3 | (42.9%) | 4 | (57.1%) | 1 | (14.3%) |
Mandible Cancer | 12 | 8 | (66.7%) | 1 | (8.3%) | 8H 56′ | (536′) | 8 | (66.7%) | 4 | (33.3%) | 1 | (8.3%) |
Iliac Crest | 8 | 5 | (62.5%) | 1 | (12.5%) | 8H 41′ | (521′) | 5 | (62.5%) | 3 | (37.5%) | 1 | (12.5%) |
Fibula | 3 | 3 | (100%) | 0 | (0%) | 9H 46′ | (586′) | 2 | (66.7%) | 1 | (33.3%) | 0 | (0%) |
Other | 1 | 0 | (0%) | 0 | (0%) | 8H 28′ | (508′) | 1 | (100%) | 0 | (0%) | 0 | (0%) |
Trauma | 5 | 5 | (100%) | 0 | (0%) | 9H 9′ | (549′) | 1 | (20%) | 4 | (80%) | 1 | (20%) |
Fibula | 4 | 4 | (100%) | 0 | (0%) | 9H 41′ | (581′) | 1 | (25%) | 3 | (75%) | 0 | (0%) |
Other | 1 | 1 | (100%) | 0 | (0%) | 7H 0′ | (420′) | 0 | (0%) | 1 | (100%) | 1 | (100%) |
TOTAL | 107 | 76 | (71%) | 10% | (10%) | 9H 26′ | (566′) | 57 | (53.3%) | 50 | (46.7%) | 30 | (28%) |
N | Flap Loss | Partial Necrosis | Surgical | Surgical-Site | Cervical | Pneumonia | Overall Complications | Death | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Complications | Infection | Haematoma | within 1 Year | ||||||||||||||||
Age (Average) | 59.8 ± 14.4 | 56.2 ± 9.43 * | (p = 0.088) | 63.8 ± 13.4 | 54.8 ± 13.8 | 59.3 ± 10.6 | 62.6 ± 15.0 | 60.2 ± 14.5 | 60.0 ± 13.9 | (p = 0.781) | 68.8 ± 12.0 | ||||||||
Phyisical Status | * | (p = 0.044) | (p = 0.084) | ||||||||||||||||
ASA 1 | 6 | 0 | (0%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 2 | (33.3%) | 0 | (0%) | ||
ASA 2 | 55 | 2 | (3.6%) | 6 | (10.9%) | 16 | (29.1%) | 12 | (21.8%) | 13 | (23.6%) | 11 | (20%) | 42 | (76.4%) | 8 | (14.5%) | ||
ASA 3 | 46 | 8 | (17.4%) | 6 | (13%) | 10 | (21.7%) | 12 | (26.1%) | 10 | (21.7%) | 12 | (26.1%) | 32 | (69.6%) | 6 | (13%) | ||
BMI < 18 | 12 | 3 | (25%) * | (p = 0.048) | 3 | (25%) | 7 | (58.3%) | 3 | (25%) | 6 | (50%) | 4 | (33.3%) | 9 | (75%) | (p = 0.748) | 4 | (33.3%) |
BMI > 25 | 50 | 2 | (4%) | (p = 0.075) | 5 | (10%) | 10 | (20%) | 10 | (20%) | 10 | (20%) | 9 | (18%) | 33 | (66%) | (p = 0.283) | 6 | (12%) |
Normal BMI | 45 | 5 | (11.1%) | 4 | (8.9%) | 9 | (20%) | 11 | (24.4%) | 8 | (17.8%) | 10 | (22.2%) | 34 | (75.6%) | 4 | (8.9%) | ||
Previous Comorbidities | |||||||||||||||||||
Arterial Hipertension | 39 | 2 | (5.1%) | (p = 0.256) | 6 | (15.4%) | 7 | (17.9%) | 8 | (20.5%) | 10 | (25.6%) | 9 | (23.1%) | 27 | (69.2%) | (p = 0.756) | 6 | (15.4%) |
Cardiac Insufficiency | 8 | 1 | (12.5%) | (p = 0.750) | 2 | (25%) | 4 | (50%) | 1 | (12.5%) | 5 | (62.5%) | 3 | (37.5%) | 4 | (50%) | (p = 0.173) | 3 | (37.5%) |
Vascular Events | 12 | 0 | (0%) | (p = 0.238) | 1 | (8.3%) | 4 | (33.3%) | 2 | (16.7%) | 3 | (25%) | 3 | (25%) | 8 | (66.7%) | (p = 0.724) | 3 | (25%) |
Diabetes Mellitus | 11 | 1 | (9.1%) | (p = 0.976) | 2 | (18.2%) | 1 | (9.1%) | 4 | (36.4%) | 3 | (27.3%) | 2 | (18.2%) | 9 | (81.8%) | (p = 0.405) | 1 | (9.1%) |
Dyslipidemia | 40 | 2 | (5%) | (p = 0.233) | 4 | (10%) | 5 | (12.5%) | 10 | (25%) | 9 | (22.5%) | 4 | (10%) * | 27 | (67.5%) | (p = 0.534) | 4 | (10%) |
Respiratory Disease | 17 | 2 | (11.8%) | (p = 0.709) | 3 | (17.6%) | 5 | (29.4%) | 6 | (35.3%) | 5 | (29.4%) | 5 | (29.4%) | 12 | (70.6%) | (p = 0.965) | 4 | (23.5%) |
Other Neoplasy | 15 | 3 | (20%) | (p = 0.126) | 2 | (13.3%) | 2 | (13.3%) | 5 | (33.3%) | 3 | (20%) | 6 | (40%) | 13 | (86.7%) | (p = 0.150) | 2 | (13.3%) |
Chronic Pain | 25 | 4 | (16%) | (p = 0.192) | 4 | (16%) | 10 | (40%) | 8 | (32%) | 8 | (32%) | 6 | (24%) | 18 | (72%) | (p = 0.903) | 5 | (20%) |
Consumption Habits | |||||||||||||||||||
Alcohol use | 29 | 4 | (13.8%) | (p = 0.443) | 3 | (10.3%) | 9 | (31%) | 8 | (27.6%) | 6 | (20.7%) | 6 | (20.7%) | 20 | (69%) | (p = 0.354) | 4 | (13.8%) |
Alcohol abuse | 15 | 2 | (13.3%) | 3 | (20%) | 5 | (33.3%) | 6 | (40%) | 5 | (33.3%) | 6 | (40%) | 13 | (86.7%) | 1 | (6.7%) | ||
Tobbaco Use | 29 | 4 | (13.8%) | (p = 0.346) | 3 | (10.3%) | 9 | (31%) | 8 | (27.6%) | 3 | (10.3%) | 9 | (31%) | 22 | (75.9%) | (p = 0.721) | 3 | (10.3%) |
Ex-Smoker | 14 | 0 | (0%) | 2 | (14.3%) | 4 | (28.6%) | 2 | (14.3%) | 5 | (35.7%) | 3 | (21.4%) | 9 | (64.3%) | 2 | (14.3%) | ||
Surgical-Site History | |||||||||||||||||||
Tumor Recidive | 28 | 2 | (7.1%) | (p = 0.344) | 4 | (14.3%) | 7 | (25%) | 8 | (28.6%) | 7 | (25%) | 8 | (28.6%) | 19 | (67.9%) | (p = 0.814) | 4 | (14.3%) |
Previous Surgery | 49 | 8 | (16.3%) | (p = 0.137) | 8 | (16.3%) | 14 | (28.6%) | 14 | (28.6%) | 10 | (20.4%) | 15 | (30.6%) | 37 | (75.5%) | (p = 0.752) | 5 | (10.2%) |
Radiotherapy History | 32 | 7 | (21.9%) | (p = 0.063) | 5 | (15.6%) | 10 | (31.3%) | 9 | (28.1%) | 8 | (25%) | 10 | (31.3%) | 26 | (81.3%) | (p = 0.415) | 4 | (12.5%) |
Medication History | |||||||||||||||||||
Antiplatelet | 7 | 1 | (14.3%) * | (p = 0.019) | 2 | (28.6%) | 2 | (28.6%) | 2 | (28.6%) | 3 | (42.9%) | 3 | (42.9%) | 7 | (100%) | (p = 0.376) | 3 | (42.9%) |
Anticoagulation | 4 | 0 | (0%) | (p = 0.513) | 0 | (0%) | 1 | (25%) | 1 | (25%) | 2 | (50%) | 0 | (0%) | 2 | (50%) | (p = 0.345) | 1 | (25%) |
Sedatives | 31 | 2 | (6.5%) | (p = 0.511) | 1 | (3.2%) | 9 | (29%) | 4 | (12.9%) | 9 | (29%) | 5 | (16.1%) | 21 | (67.7%) | (p = 0.645) | 5 | (16.1%) |
Opioids | 15 | 2 | (13.3%) | (p = 0.562) | 3 | (20%) | 4 | (26.7%) | 6 | (40%) | 6 | (40%) | 4 | (26.7%) | 11 | (73.3%) | (p = 0.832) | 4 | (26.7%) |
Total | 107 | 10 | (9.3%) | 12 | (11.2%) | 26 | (24.3%) | 24 | (22.4%) | 24 | (22.4%) | 23 | (21.5%) | 76 | (71%) | 14 | (13.1%) |
In-Hospital Postoperative Death Description | |||
---|---|---|---|
Age | Reason for Surgery | Cause of Death | |
Patient 1 | 69 | Oral tumour recidive after prior surgery and radiation therapy | Dislocation of gastrostomy tube with massive intraperitoneal haemorrhage and peritonitis. Bacteriemia with Enterobacter cloacae followed by sepsis and multiple organ failure. |
Patient 2 | 50 | Oral tumour recidive after prior surgery and radiation therapy | Nosocomial Pneumonia at the 4th postoperative day (Pseudomonas aeruginosa, MDR), not responding to large-spectrum antibiotics, with evolution to respiratory failure. |
Patient 3 | 89 | Tongue cancer | Postoperative airway obstruction, submitted to emergency cricothiroidostomy, resulting in diffuse anoxic encephalopathy and deterioration to neurological vegetative state. |
Patient 4 | 80 | Nasal septum carcinoma | Duodenal ulcera with massive digestive haemorrhage (hipovolaemic shock) + Fungemia + Urinary tract Infection and CVC contamination |
REMI | MMOD | OFA | Total | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Blood Loss and IntrOp Transfusion | 58 | 49 | 30 | 107 | ||||||
Reported Blood Loss (mL) | 645 ± 368 | 845 ± 619 | (p = 0.236) | 827 ± 707 | (p = 0.314) | 739 ± 511 | ||||
Haemorrhage HbCalc (mL) | 1581 ± 653 | 1669 ± 749 | (p = 0.332) | 1675 ± 897 | (p = 0.918) | 1664 ± 695 | ||||
Hb Decrease (g/dL) | 4.61 ± 1.94 | 4.13 ± 1.96 | (p = 0.986) | 3.62 ± 2.18 * | (p = 0.011) | 4.39 ± 1.95 | ||||
Transfusion IntraOp (N patients) | 15 (25.9%) | 22 (44.9%) | (p = 0.096) | 16(53.3%) | (p = 0.079) | 37 (34.6%) | ||||
Units RBC IntraOp/Patient (N) | 1.9 ± 1.2 | 2.8 ± 1.8 * | (p = 0.004) | 3.4 ± 1.9 * | (p = 0.001) | 2.43 ± 1.67 | ||||
IntraOp Haemodinamic Interventions | ||||||||||
Sympatomimetics use (N patients) | 28 (48.3%) | 24 (49.0%) | 18 (60.0%) | 52 (48.6%) | ||||||
Vasopressor IntraOp (N patients) | 25 (43.1%) | 15 (30.6%) | 10 (33.3%) | 40 (37.4%) | ||||||
Dobutamine IntraOp (N patients) | 3 (5.2%) | 9 (18.4%) | 8 (26.7%) | 12 (11.2%) | ||||||
Vasodilator IntraOp (N patients) | 6 (10.3%) | 19 (38.8%) | 13 (43.3%) | 25 (23.4%) | ||||||
Fluid Therapy and Balance | ||||||||||
Fluid IntraOp (mL/Kg) | 90.6 ± 33.3 | 113 ± 34 * | (p = 0.001) | 117 ± 36 * | (p = 0.003) | 101 ± 35 | ||||
Fluid Rate IntraOp (mL/Kg/H) | 8.59 ± 2.96 | 9.96 ± 2.25 * | (p = 0.006) | 10.49 ± 2.32 * | (p = 0.002) | 9.17 ± 2.74 | ||||
Diuresis IntraOp (mL/kg/h) | 2.1 ± 1.36 | 3.1 ± 1.58 * | (p = 0.004) | 3.23 ± 1.69 * | (p = 0.002) | 2.56 ± 1.54 | ||||
Total Fluid Losses Reported (mL) | 3907 ± 2448 | 6335 ± 3030 * | (p = 0.002) | 7573 ± 2414 * | (p = 0.001) | 5019 ± 2976 | ||||
“Hidden” Fluid Losses (mL/kg/h) | 2.53 ± 2.69 | 4.66 ± 3.24 * | (p = 0.001) | 6.38 ± 2.1 * | (p = 0.001) | 3.38 ± 3.1 | ||||
Reported Net Fluid Balance (mL) | 2228 ± 2018 | 1311 ± 2199 * | (p = 0.027) | 344 ± 1751 * | (p = 0.001) | 1808 ± 2142 | ||||
HbCalc Net Fluid Balance (mL) | 1217 ± 2448 | 548 ± 2112 | (p = 0.114) | −403 ± 1745 * | (p = 0.001) | 911 ± 2180 | ||||
Intensive Care Unit endpoints | ||||||||||
Traqueostomy (N patients) | 47 (81%) | 40 (81.6%) | 24 (80%) | 87 (81.3%) | ||||||
IMV at ICU Admission | 46 (79.3%) | 15 (30.6%) * | (p = 0.001) | 1 (3.3%) * | (p = 0.001) | 61 (57%) | ||||
T Mechanical Ventilation (H) | 81 ± 97 | 33 ± 95 | (p = 0.082) | 9 ± 38 * | (p = 0.029) | 82 ± 97 | ||||
Transfusion ICU (N) | 22 (37.9%) | 16 (32.7%) | (p = 0.411) | 7 (23.3%) | (p = 0.068) | 38 (35.5%) | ||||
Units RBC ICU/Patient | 2.23 ± 2.6 | 3 ± 1.9 | (p = 0.133) | 3 ± 2.2 | (p = 0.241) | 2.29 ± 2.3 | ||||
Vasopressor ICU (N) | 27 (46.6%) | 10 (20.4%) * | (p = 0.005) | 3 (10%) * | (p = 0.001) | 37 (34.6%) |
N | Spontaneous Vent. | IMV ICU | Start Training | Complete Clamp | Cannula Removal | Tracheal Secretions | Pneumonia | Complications | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
ICU Admission (N) | (Hours) | (Days) | (Days) | (Days) | (N) | (N) | Overall (N) | |||||||||
Opioid-Base | 58 | 13 | (22.4%) | 66.3 ± 97.2 | 9 | (15.5%) | 16 | (27.6%) | 45 | (77.6%) | ||||||
Traqueostomy | 47 | 8 | (17%) | 75.7 ± 105 | 13.3 ± 13.2 | 18.9 ± 18.1 | 21 ± 18.9 | 9 | (19.1%) | 14 | (29.8%) | 39 | 82.98% | |||
Tracheal Tube | 11 | 5 | (45.5%) | 27.3 ± 33 | 0 | (0%) | 2 | (18.2%) | 6 | 54.54% | ||||||
Multimodal | 49 | 34 | (69.4%) * | 33.1 ± 94.7 | (p = 0.248) | (p = 0.131) | (p = 0.712) | 3 | (6.1%) * | 6 | (12.2%) * | 31 | (63.3%) * | |||
Traqueostomy | 40 | 26 | (65%) | 36.8 ± 103.2 | 10.7 ± 5.4 | 14.2 ± 5.9 | 19.7 ± 10.6 | 3 | (7.5%) | 5 | (12.5%) | 28 | 70% | |||
Tracheal Tube | 9 | 8 | (88.9%) | 16.4 ± 39.3 | 0 | (0%) | 1 | (11.1%) | 3 | 33.33% | ||||||
Opioid-Free | 30 | 29 | (96.7%) * | 9.2 ± 38.4 * | (p = 0.550) | (p = 0.524) | (p = 0.842) | 1 | (3.3%) * | 4 | (13.3%) * | 16 | (53.3%) * | |||
Traqueostomy | 24 | 23 | (95.8%) | 11 ± 42.9 | 11 ± 5.2 | 15.1 ± 5.9 | 19.9 ± 9.2 | 1 | (4.2%) | 3 | (12.5%) | 14 | 58.30% | |||
Tracheal Tube | 6 | 5 | (80%) | 2 ± 4.9 | 0 | (0%) | 1 | (16.7%) | 2 | 33.33% | ||||||
Total | 107 | 47 | (43.9%) | 50.8 ± 97 | 11 | (10.3%) | 24 | (22.4%) | 76 | (71%) | ||||||
Traqueostomy | 87 | 34 | (39.1%) | 57.3 ± 105.2 | 12.1 ± 10.4 | 16.9 ± 14.1 | 20.4 ± 15.6 | 11 | (12.6%) | 20 | (23%) | 67 | 77.01% | |||
Tracheal Tube | 20 | 13 | (65%) | 22.4 ± 35.9 | 0 | (0%) | 4 | (20%) | 9 | 45% |
REMI | MMOD | OFA | Total | |
---|---|---|---|---|
N = 58 | N = 49 | N = 30 | N = 107 | |
Intraoperative Administration | ||||
Minor Analgesics (N) | 37 (63.8%) | 45 (91.8%) | 29 (96.7%) | 82 (76.6%) |
Pre-Emptive Analgesia (N) | 6 (10.3%) | 31 (63.3%) | 20 (66.7%) | 37 (34.6%) |
Ketamine Bolus (N) | 15 (25.9%) | 1 (2%) | 0 (0%) | 16 (15%) |
Ketamine Infusion (N) | 2 (3.4%) | 48 (98%) | 30 (100%) | 50 (46.7%) |
Lidocaine Bolus (N) | 10 (17.2%) | 1 (2%) | 0 (0%) | 11 (10.3%) |
Lidocaine Perfusion (N) | 17 (29.3%) | 47 (95.9%) | 30 (100%) | 64 (59.8%) |
MgSO4 Bolus (N) | 10 (17.2%) | 25 (51%) | 9 (30%) | 35 (32.7%) |
MgSO4 Perfusion (N) | 0 (0%) | 14 (28.6%) | 14 (46.7%) | 14 (13.1%) |
Rocuronium (IntraOp mg) | 233 ± 113 | 250 ± 140 | 195 ± 85 * | 240 ± 126 |
Rocuronium (mg/kg) | 3.38 ± 1.63 | 3.75 ± 2.29 | 2.78 ± 1.14 * | 3.55 ± 1.96 |
Rocuronium (mg/kg/h) | 0.373 ± 0.17 | 0.379 ± 0.21 | 0.295 ± 0.12 * | 0.376 ± 0.19 |
Long-Duration Opioid IntraOp (N) | 28 (48.3%) | 2 (4.1%) | 30 (28%) | |
Morphine Equivalent (mg/Patient) | 6.46 ± 3.48 | 3 ± 4.94 | 6.47 ± 3.48 | |
Morphine Equivalent (mg/kg) | 0.1 ± 0.06 | 0.04 ± 0.06 | 0.1 ± 0.06 | |
Safety and Efficiency | ||||
Analgesia Complications (N) | 35 (60.3%) | 22 (44.9%) | 7 (23.3%) * | 57 (53.3%) |
Pain [VAS > 3] ICU (N) | 9 (15.5%) | 6 (12.2%) | 2 (6.7%) * | 15 (14%) |
Pain [VAS > 3] PSW (N) | 9 (15.5%) | 4 (8.2%) * | 2 (6.7%) * | 13 (12.1%) |
N | Pain ICU | Pain Ward | Complications | Flap Loss | Complications | IMV ICU | GI Nutrition | LOS ICU | Hospitalization | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
(N) | (N) | Analgesia (N) | (N) | Overall (N) | (Hours) | (Hours) | (Days) | (Days) | |||||||
REMI | 58 | 9 | (15.5%) | 9 | (15.5%) | 35 | (60.3%) | 7 | (12.1%) | 45 | (77.6%) | 66 ± 97 | 60 ± 35 | 5.3 ± 4.7 | 27.1 ± 17.0 |
Fentanil (P) | 14 | 2 | (14.3%) | 3 | (21.4%) | 12 | (85.7%) | 3 | (21.4%) | 12 | (85.7%) | 113 | 63 | 7.2 | 39.3 |
Tramadol (P) | 30 | 2 | (6.7%) | 4 | (13.3%) | 15 | (50%) | 3 | (10%) | 22 | (73.3%) | 45 | 49 | 4.3 | 21.5 |
Ketamine (P) High-Dose | 4 | 2 | (50%) | 1 | (25%) | 4 | (100%) | 0 | (0%) | 3 | (75%) | 108 | 111 | 6.8 | 41.5 |
Morphine (B) | 5 | 1 | (20%) | 0 | (0%) | 3 | (60%) | 1 | (20%) | 3 | (60%) | 26 | 78 | 5 | 20 |
Minor Analgesics Only (UCI) | 5 | 2 | (40%) | 1 | (20%) | 1 | (20%) | 0 | (0%) | 5 | (100%) | 67 | 58 | 5.4 | 22.4 |
MMOD | 49 | 6 | (12.2%) | 4 | (8.2%) * | 22 | (44.9%) | 3 | (6.1%) * | 31 | (63.3%) | 33 ± 95 | 46 ± 55 | 3.9 ± 3.1 * | 24 ± 13.7 |
Fentanil (P) | 10 | 4 | (40%) | 1 | (10%) | 9 | (90%) | 2 | (20%) | 9 | (90%) | 112 | 78 | 5.1 | 30 |
Tramadol (P) | 4 | 1 | (25%) | 0 | (0%) | 3 | (75%) | 0 | (0%) | 4 | (100%) | 42 | 48 | 7 | 28 |
Ketamine (P) High-Dose | 1 | 0 | (0%) | 0 | (0%) | 1 | (100%) | 0 | (0%) | 1 | (100%) | 60 | 72 | 4 | 17 |
Morphine (B) | 2 | 0 | (0%) | 1 | (50%) | 2 | (100%) | 0 | (0%) | 0 | (0%) | 8 | 30 | 3 | 10 |
PCA Ketamine | 31 | 0 | (0%) | 1 | (3.2%) | 6 | (19.4%) | 1 | (3.2%) | 16 | (51.6%) | 8 | 37 | 3.3 | 23 |
Minor Analgesics Only (UCI) | 1 | 1 | (100%) | 1 | (100%) | 1 | (100%) | 0 | (0%) | 1 | (100%) | 0 | 12 | 1 | 27 |
OFA | 30 | 2 | (6.7%) | 2 | (6.7%) * | 7 | (23.3%) * | 1 | (3.3%) * | 16 | (53.3%) * | 9 ± 38 * | 41 ± 56 * | 3.4 ± 3.5 * | 24.1 ± 13.1 * |
Tramadol (P) | 2 | 1 | (50%) | 0 | (0%) | 1 | (50%) | 0 | (0%) | 2 | (100%) | 30 | 60 | 7.5 | 34 |
PCA Ketamine | 27 | 0 | (0%) | 1 | (3.7%) | 5 | (18.5%) | 1 | (3.7%) | 13 | (48.1%) | 8 | 40 | 3.2 | 23.3 |
Minor Analgesics Only (UCI) | 1 | 1 | (100%) | 1 | (100%) | 1 | (100%) | 0 | (0%) | 1 | (100%) | 0 | 12 | 1 | 27 |
Total | 107 | 15 | (14%) | 13 | (12.1%) | 57 | (53.3%) | 10 | (9.3%) | 76 | (71%) | 51 ± 97 | 54 ± 45 | 4.7 ± 4.1 | 25.7 ± 5.6 |
Fentanil (P) | 24 | 6 | (25%) * | 4 | (16.7%) | 21 | (87.5%) * | 5 | (20.8%) | 21 | (87.5%) | 112 * | 70 | 6.3 * | 35.5 * |
Tramadol (P) | 34 | 3 | (8.8%) | 4 | (11.8%) | 18 | (52.9%) | 3 | (8.8%) | 26 | (76.5%) | 44 | 49 | 4.6 | 22.2 |
Ketamine (P) High-Dose | 5 | 2 | (40%) * | 1 | (20%) * | 5 | (100%) * | 0 | (0%) | 4 | (80%) | 98 * | 103 * | 6.2 | 36.6 * |
Morphine (B) | 7 | 1 | (14.3%) | 1 | (14.3%) | 5 | (71.4%) | 1 | (14.3%) | 3 | (42.9%) | 21 | 64 | 4.4 | 17 |
PCA Ketamine | 31 | 0 | (0%) | 1 | (3.2%) | 6 | (19.4%) | 1 | (3.2%) | 16 | (51.6%) | 8 | 37 | 3.3 | 22.6 |
Minor Analgesics Only (UCI) | 6 | 3 | (50%) | 2 | −33.30% | 2 | (33.3%) | 0 | (0%) | 6 | (100%) | 56 | 50 | 4.7 | 23.2 |
N | Overall | Surgical | Flap Loss | Hematoma | Site Infection | Pneumonia | Secretions | ICU Lenght of Stay | Hospitalization | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Complications | Complications | (Days) | (Days) | ||||||||||||||
REMI | 58 | 45 | (77.6%) | 13 | (22.4%) | 7 | (12.1%) | 13 | (22.4%) | 15 | (25.9%) | 17 | (29.3%) | 8 | (13.8%) | 4.84 ± 4.74 | 29.11 ± 17.02 |
Head & Neck Cancer | 45 | 33 | (73.3%) | 8 | (17.8%) | 10 | (22.2%) | 11 | (24.4%) | 12 | (26.7%) | 10 | (22.2%) | 7 | (15.6%) | 5.67 ± 5.22 | 26.3 ± 16.95 |
Radionecrosis | 12 | 10 | (83.3%) | 5 | (41.7%) | 4 | (33.3%) | 2 | (16.7%) | 3 | (25%) | 2 | (16.7%) | 1 | (8.3%) | 4.27 ± 2.28 | 30.09 ± 19.17 |
Other Causes | 2 | 2 | (100%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 3 ± 0 | 28.5 ± 7.78 |
MMOD | 49 | 31 | (63.3%) | 13 | (26.5%) | 3 | (6.1%) | 11 | (22.4%) | 9 | (18.4%) | 7 | (14.3%) * | 3 | (6.1%) | 3.92 ± 3.06 * | 24 ± 13.66 |
Head & Neck Cancer | 36 | 20 | (55.6%) | 8 | (22.2%) | 1 | (2.8%) | 9 | (25%) | 6 | (16.7%) | 4 | (11.1%) | 1 | (2.8%) | 4.05 ± 3.23 | 22.02 ± 12.34 |
Radionecrosis | 10 | 9 | (90%) | 5 | (50%) | 2 | (20%) | 2 | (20%) | 2 | (20%) | 4 | (40%) | 1 | (10%) | 3.6 ± 2.63 | 33.3 ± 15.59 |
Other Causes | 3 | 3 | (100%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 1 | (33.3%) | 0 | (0%) | 1 | (33.3%) | 3 ± 2 | 22.33 ± 14.74 |
OFA | 30 | 16 | (53.3%) * | 7 | (23.3%) | 1 | (3.3%) * | 8 | (26.7%) | 4 | (13.3%) | 4 | (13.3%) * | 1 | (3.3%) * | 3.43 ± 3.51 * | 24.1 ± 13.1 * |
Head & Neck Cancer | 24 | 11 | (45.8%) | 5 | (20.8%) | 1 | (4.2%) | 7 | (29.2%) | 3 | (12.5%) | 3 | (12.5%) | 1 | (4.2%) | 3.91 ± 3.77 | 22.96 ± 11.04 |
Radionecrosis | 6 | 5 | (83.3%) | 2 | (33.3%) | 0 | (0%) | 1 | (16.7%) | 1 | (16.7%) | 2 | (33.3%) | 0 | (0%) | 1.83 ± 0.75 | 33 ± 18.24 |
TOTAL | 107 | 76 | (71%) | 26 | (24.3%) | 10 | (9.3%) | 24 | (22.4%) | 24 | (22.4%) | 24 | (22.4%) | 11 | (10.3%) | 4.67 ± 4.1 | 25.7 ± 15.57 |
Head & Neck Cancer | 82 | 53 | (64.6%) | 16 | (19.5%) | 4 | (4.9%) | 20 | (24.4%) | 18 | (22%) | 19 | (23.2%) | 8 | (9.8%) | 4.93 ± 4.48 | 24.39 ± 15.11 |
Radionecrosis | 21 | 19 | (90.5%) * | 10 | (47.6%) * | 6 | (28.6%) * | 4 | (19%) | 5 | (23.8%) | 6 | (28.6%) | 2 | (9.5%) | 3.95 ± 2.42 | 31.61 ± 17.2 * |
Other Causes | 5 | 5 | (100%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 1 | (20%) | 0 | (0%) | 1 | (20%) | 3 ± 1.15 | 24.8 ± 11.63 |
N | Blood Loss | Blood Loss | Hb Decrease | Transfusion | Transfusion | Vasopressor ICU | Hematoma | Flap Loss | Complications | Complications | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Reported (mL) | Calculated (mL) | (g/dL) | (Units RBC) | N | N | N | N | Surgical (N) | Overall (N) | |||||||||
Heparin | 11 | 1345 ± 838 | 1884 ± 908 | 5.12 ± 1.97 | 1.72 ± 2.57 | 5 | (45.5%) | 8 | (72.7%) | 6 | (54.5%) | 4 | (36.4%) | 7 | (63.6%) | 9 | (81.8%) | |
Remifentanil | (13.8%) | 8 | 731 | 1603 | 4.43 | 0.75 | 2 | (25%) | 5 | (62.5%) | 4 | (50%) | 3 | (37.5%) | 4 | (50%) | 6 | (75%) |
Multimodal | (6.1%) | 3 | 1900 | 2635 | 7 | 4.33 | 2 | (66.7%) | 3 | (100%) | 2 | (66.7%) | 1 | (33.3%) | 3 | (100%) | 3 | (100%) |
Opioid-Free | (3.3%) | 1 | 3250 | 4257 | 9.7 | 6 | 1 | (100%) | 1 | (100%) | 1 | (100%) | 0 | (0%) | 1 | (100%) | 1 | (100%) |
AAS + TNX | 23 | 853 ± 463 | 1510 ± 520 | 3.82 ± 1.66 | 0.61 ± 1.34 | 7 | (30.4%) | 4 | (17.4%) | 3 | (13%) | 1 | (4.3%) | 5 | (21.7%) | 15 | (65.2%) | |
Remifentanil | (3.4%) | 2 | 950 | 1083 | 3.35 | 0.61 | 0 | (0%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 1 | (50%) |
Multimodal | (42.9%) | 21 | 844 | 1551 | 3.86 | 0.67 | 7 | (33.3%) | 4 | (19%) | 3 | (14.3%) | 1 | (4.8%) | 5 | (23.8%) | 14 | (66.7%) |
Opioid-Free | (46.7%) | 14 | 830 | 1500 | 3.18 | 0.71 | 4 | (28.6%) | 1 | (7.1%) | 3 | (21.4%) | 0 | (0%) | 3 | (21.4%) | 9 | (64.3%) |
AAS Only | 15 | 797 ± 377 | 1472 ± 622 | 4.35 ± 1.93 | 0.53 ± 0.96 | 4 | (26.7%) | 3 | (20%) | 2 | (13.3%) | 1 | (6.7%) | 4 | (26.7%) | 8 | (53.3%) | |
Remifentanil | (13.8%) | 8 | 806 | 1682 | 5.05 | 0.63 | 3 | (37.5%) | 2 | (25%) | 1 | (12.5%) | 0 | (0%) | 2 | (25%) | 5 | (62.5%) |
Multimodal | (14.3%) | 7 | 786 | 1233 | 3.54 | 0.43 | 1 | (14.3%) | 1 | (14.3%) | 1 | (14.3%) | 1 | (14.3%) | 2 | (28.6%) | 3 | (42.9%) |
Opioid-Free | (13.3%) | 4 | 575 | 1052 | 2.7 | 0 | 0 | (0%) | 0 | (0%) | 0 | (0%) | 1 | (25%) | 0 | (0%) | 1 | (25%) |
TNX Only | 7 | 1114 ± 907 | 1919 ± 1060 | 3.17 ± 2.02 | 0.86 ± 1.21 | 3 | (42.9%) | 1 | (14.3%) | 2 | (28.6%) | 0 | (0%) | 2 | (28.6%) | 4 | (57.1%) | |
Remifentanil | (1.7%) | 1 | 1000 | 1967 | 3.2 | 1 | 1 | (100%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 0 | (0%) | 1 | (100%) |
Multimodal | (12.2%) | 6 | 1133 | 1911 | 3.16 | 0.83 | 5 | (83.3%) | 1 | (16.7%) | 2 | (33.3%) | 0 | (0%) | 2 | (33.3%) | 3 | (50%) |
Opioid-Free | (20%) | 6 | 1133 | 1911 | 3.16 | 0.83 | 5 | (83.3%) | 1 | (16.7%) | 2 | (33.3%) | 0 | (0%) | 2 | (33.3%) | 3 | (50%) |
None | 51 | 591 ± 345 | 1707 ± 674 | 4.67 ± 1.99 | 0.78 ± 1.92 | 19 | (37.3%) | 18 | (35.3%) | 11 | (21.6%) | 4 | (7.8%) | 8 | (15.7%) | 40 | (78.4%) | |
Remifentanil | (67.2%) | 39 | 575 | 1688 | 4.65 | 0.95 | 16 | (41%) | 17 | (43.6%) | 8 | (20.5%) | 4 | (10.3%) | 7 | (17.9%) | 32 | (82.1%) |
Multimodal | (24.5%) | 12 | 642 | 1769 | 4.72 | 0.25 | 3 | (25%) | 1 | (8.3%) | 3 | (25%) | 0 | (0%) | 1 | (8.3%) | 8 | (66.7%) |
Opioid-Free | (16.7%) | 5 | 570 | 1863 | 7.92 | 0 | 0 | (0%) | 0 | (0%) | 2 | (40%) | 0 | (0%) | 1 | (20%) | 2 | (40%) |
Total | 107 | 757 ± 511 | 1664 ± 695 | 4.39 ± 1.95 | 0.81 ± 1.75 | 38 | (35.5%) | 34 | (31.8%) | 24 | (22.4%) | 10 | (9.3%) | 26 | (24.3%) | 76 | (71%) | |
Remifentanil | (100%) | 58 | 649 | 1659 | 4.61 | 0.84 | 20 | (34.5%) | 24 | (41.4%) | 13 | (22.4%) | 7 | (12.1%) | 13 | (22.4%) | 45 | (77.6%) |
Multimodal | (100%) | 49 | 886 | 1669 | 4.13 | 0.78 | 16 | (32.7%) | 10 | (20.4%) | 11 | (22.4%) | 3 | (6.1%) | 13 | (26.5%) | 31 | (63.3%) |
Opioid-Free | (100%) | 30 | 894 | 1675 | 3.62 | 0.7 | 5 | (16.7%) | 3 | (10%) | 8 | (26.7%) | 1 | (3.3%) | 7 | (23.3%) | 16 | (53.3%) |
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Ferreira, P.-R.C.; De Oliveira, R.I.P.; Vaz, M.D.; Bentes, C.; Costa, H. Opioid-Free Anaesthesia Reduces Complications in Head and Neck Microvascular Free-Flap Reconstruction. J. Clin. Med. 2023, 12, 6445. https://doi.org/10.3390/jcm12206445
Ferreira P-RC, De Oliveira RIP, Vaz MD, Bentes C, Costa H. Opioid-Free Anaesthesia Reduces Complications in Head and Neck Microvascular Free-Flap Reconstruction. Journal of Clinical Medicine. 2023; 12(20):6445. https://doi.org/10.3390/jcm12206445
Chicago/Turabian StyleFerreira, Paulo-Roberto Cardoso, Rita Isabel Pinheiro De Oliveira, Marta Dias Vaz, Carla Bentes, and Horácio Costa. 2023. "Opioid-Free Anaesthesia Reduces Complications in Head and Neck Microvascular Free-Flap Reconstruction" Journal of Clinical Medicine 12, no. 20: 6445. https://doi.org/10.3390/jcm12206445