Korean J Otorhinolaryngol-Head Neck Surg.  2014 Mar;57(3):172-177. 10.3342/kjorl-hns.2014.57.3.172.

Comparison of Two Sedation Protocols for Postoperative Intensive Care Unit Care after Head and Neck Reconstructive Surgery: Midazolam/Morphine versus Remifentanil Sedation

• Lee NJ
• Jang JY
• Choi SY
• Park KN
• Baek CH
• Park JS
• Park SH
• Jeong HS

• KMID: 2277888
• DOI: http://doi.org/10.3342/kjorl-hns.2014.57.3.172

Abstract

BACKGROUND AND OBJECTIVES
In head and neck reconstructive surgery, the stability of vital signs is important for patient recovery and flap outcome. We aimed to determine the better sedation protocol by comparing two protocols, namaely, midazolam/morphine (MM)-based and remifentanil (RF)-based sedation protocols, in the immediate postoperative settings of head and neck reconstructive surgery.
SUBJECTS AND METHOD
We retrospectively reviewed the medical data of patients who underwent reconstructive surgery after the ablation of head and neck cancer involving MM sedation (n=34) or RF sedation (n=28). Parameters related to vital signs, flap outcomes, occurrence of delirium, length of stay and nursing burden were compared between the groups.
RESULTS
The length of stay at the intensive care unit and flap outcomes were similar in the two groups. However, blood pressure as measured by frequency of variation was more stable in the RF group than in the MM group. In addition, the number of medical calls from the attending nurse due to the fluctuation of vital signs was less in the RF group than in the MM group.
CONCLUSION
RF-based sedation for the postoperative intensive care unit care after head and neck reconstructive surgery is more effective in cases where vital signs are less stable. This type of sedation may decrease the nursing burden for these patients.

Keyword

Free flap; Head and neck surgery; Postoperative care; Reconstruction; Sedation

MeSH Terms

Blood Pressure
Delirium
Free Tissue Flaps
Head and Neck Neoplasms
Head*
Humans
Intensive Care Units*
Critical Care*
Length of Stay
Neck*
Nursing
Postoperative Care
Retrospective Studies
Vital Signs