Anesthetic techniques for pharyngeal flap surgery: effects on postoperative complications.

OBJECTIVE To assess the effects of 2 different anesthetic techniques on early complications after superior pharyngeal flap surgery. DESIGN Randomized, prospective, single-blind study. SETTING Large referral hospital. PATIENTS One hundred patients undergoing superior pharyngeal flap surgery for the correction of velopharyngeal insufficiency were randomly divided into 2 equal groups to receive either isoflurane or propofol-based anesthesia. INTERVENTIONS Following induction of anesthesia with fentanyl citrate and propofol, patients were randomized to receive either isoflurane or propofol for the maintenance of general anesthesia. The inspired isoflurane concentration and propofol infusion rate were adjusted to maintain a stable depth of anesthesia as judged by clinical signs and hemodynamic responses to surgical stimuli. MAIN OUTCOME MEASURES Recovery from anesthesia, recovery from surgery, and early postoperative complications. RESULTS The groups were similar in age, weight, height, induction time, surgery time, extubation time, and anesthetic time. The time (mean +/- SD) required to achieve a maximal Steward Recovery Score was 7 +/- 14 minutes in the propofol group compared with 32 +/- 28 minutes in the isoflurane group (P<.04). No significant differences in postoperative patient satisfaction scores, time to first swallow, drinking time, and time to "home readiness" were noted. Overall, 17 patients (17%) developed airway-related complications and 2 of the patients (2%) were accounted as severe. Two patients (2%) bled from the operation site. However, there was no difference in the incidence of postoperative complications between the groups. CONCLUSIONS When compared with isoflurane administration for maintenance of general anesthesia, propofol-based anesthesia was associated with more rapid mental and psychomotor recovery. However, airway-related complications and "home readiness" were similar between the groups.