| Summary: | 碩士 === 中臺科技大學 === 醫療暨健康產業管理系碩士班 === 103 === Abstract
Backgrounds and Purpose: There has been a substantial increase of head and neck cancer patients in Taiwan over past few years. Free flap reconstruction has become a mainstream surgery for prolonging patient’s life and enhancing the quality of medical prognosis. One of the most important roles in time consuming surgery is an anesthetic technique that stabilizes hemodynamics during operation and reduces the complications after surgery. This study is primarily concerned with the infusion volumes of surgery and post-operative complications at different methods of anesthesia for free flap surgery.
Methods: This study employed a retrospective design. Subjects were the head and neck cancer patients at a teaching medical center in central Taiwan who received “free flap reconstruction surgery”. A total of 60 patients were selected during November 2013 to April 2014 (30 of the subjects were treated inhalation anesthesia, and 30 subjects were treated intravenous anesthesia). The primary criterion for eliminating subjects was patients who had lung disease, uremia, ASA III, ASA IV, and age over 60 years old. The study variables are based on reviewing the medical records and anesthesia record sheets in order to obtain the basic patient information, diagnosis, treatments, operations, prognosis (pulmonary complications, infections, bleeding, and days in hospital), and anesthesia-related information (such as anesthesia methods, infusion volumes…etc). The analysis used the SPSS 18.0 statistical software package including Chi-square, independent t-test and others to conduct descriptive and inferential statistical analysis.
Results: The results showed that there were no statistically significant differences between two anesthesia methods in patient’s characteristic of gender, ASA classifications, height, ages, weights and Body Mass Index (BMI); no significant differences in hypertension or diabetes (p> 0.05); no significant differences in treatments of electrotherapy or chemotherapy before surgery. However, there was a significantly associated between two anesthesia methods in postoperative pulmonary complications. Besides, the operation time, infusion volumes, and urine amounts were significantly differences (p< 0.05); but the losses of blood volume and central venous pressure showed no significant differences (p> 0.05). In addition, the durations of ventilator support and the days of stay in ICU between two different anesthesia methods were no noticeable differences (p>0.05), but the days stay in hospital has significant differences (p<0.05).
Conclusions: The findings indicated that postoperative pulmonary complications are less likely to happen in free flap surgery patients who treated with total intravenous anesthesia. We also found that the amount of infusion volume for total intravenous anesthesia was significantly lower than the inhaled anesthesia. It is necessary to have professional anesthesia care for maintaining the fluid volumes to stabilize the patient’s hemodynamics in the time-consuming surgery. This study concluded that the total intravenous anesthesia method is the best valuable choice during free flap surgery.
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