A novel balanced anesthesia shortens time to emergence in patients undergoing modified radical mastectomy: a randomized prospective trial

Abstract

Background: In balanced anesthesia, protocol during the last 30 min is very important to guarantee rapid emergence and smooth extubation. In clinical practice, sevoflurane and propofol are often used in combination to achieve a better anesthetic effect and less adverse reaction. Approximately 30 min before surgical completion, sevoflurane inhalation is often discontinued and propofol is adjusted to keep sufficient depth of anesthesia.However, propofol-based anesthesia may delay time to emergence due to its unpredictable interindividual variability. In contrast, sevoflurane can be rapidly excreted unchanged from the respiratory tract, and more importantly, with minimal variability. This study aimed to investigate the effect of a novel balanced anesthesia protocol, that is propofol-based intravenous induction, propofol-sevoflurane combined maintenance, and total sevoflurane inhalation during the last 30 min of the surgery, on the time to emergence/extubation.Methods: In our study, a total of 100 female patients undergoing modified radical mastectomy were enrolled. All patients received propofol-based intravenous anesthesia for induction followed by propofolsevoflurane combined maintenance. Approximately 30 min before the end of surgery, sevoflurane was continually inhaled without propofol infusion in group Sev (n=50), while propofol was only infused in group Pro (n=50). The primary outcome was the time to emergence/extubation. The second outcomes included time to respiratory recovery, and duration of post-anesthesia care unit (PACU) stay. The hemodynamic parameters and incidences of postoperative adverse events such as hypoxemia, nausea, vomiting, dizziness, and emergence agitation (EA) were also assessed. Results:The time to emergence/extubation in group Sev was shorter than that in group Pro (12.74±4.31 vs. 17.74±4.27 min, P<0.0001). Similarly, time to respiratory recovery, and duration of PACU stay were significantly shortened in group Sev (all P<0.0001). Most of the patients in group Sev were extubated under a totally waking state of consciousness. The hemodynamic parameters and incidences of postoperative hypoxemia, nausea, vomiting, dizziness, and EA during the PACU stay were similar between the two groups.Conclusions: In patients undergoing modified radical mastectomy, this novel balanced anesthesia method could shorten the time to emergence/extubation and better waking state without increasing the incidence of adverse events.

A randomised trial: effects of different anesthesia methods on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy

“…Cancer patients have poor physical fitness due to long-term energy consumption. Inadequate perioperative analgesia can lead to body stress responses, hemodynamic fluctuations, and immune dysfunction, which are not conducive to postoperative recovery; thus, perioperative analgesia is very important (2,3). In the past, general anesthesia was often used, but the transmission of surgical trauma to the central nervous system could not be completely blocked, and it was difficult to meet the ideal anesthesia requirements (4).…”

Effects of intraoperative Magnesium Sulfate Infusion on emergency agitation during General Anesthesia in patients undergoing Radical Mastectomy: a randomized controlled study

“…With the improvement of life and the advancements in medical technology, the average lifespan of humans has extended, diseases can be diagnosed and treated timely. It is reported that 1.5 million women worldwide are diagnosed with breast cancer each year [20] . The morbidity of breast cancer is second only to that of cervical cancer, but its mortality is considerable and requires early detection, early diagnosis and early treatment.…”