Nocturnal episodic hypoxemia after ambulatory breast cancer surgery: comparison of sevoflurane and propofol-fentanyl anesthesia.
OBJECTIVE
To study the incidence and severity of nocturnal episodic hypoxemia after ambulatory breast cancer surgery and its differences with sevoflurane and propofol anesthesia.


METHODS
Sixty-one adult female patients (ASA PS I-II; age, 32-77 years) without an apparent history of sleep apnea and respiratory disease undergoing major breast cancer surgery on an outpatient basis and with planned overnight admission were randomized to one of two anesthesia maintenance groups: sevoflurane anesthesia (SEV, n = 31) or intravenous propofol, fentanyl, and vecuronium anesthesia (TIVA, n = 30). All patients were administered propofol 2 mg x kg(-1) intravenously for anesthesia induction, had a laryngeal mask airway placed, and received rectal diclofenac and local infiltration anesthesia for pain relief. No opioid analgesic or oxygen was administered after discharge from the postanesthesia care unit (PACU). Oxygen saturation (Sp(O) (2)) was recorded continuously during the first postoperative night. Sp(O) (2) <90% that lasted >10 s was regarded as hypoxemia, and the percentage of effective recording time with Sp(O) (2) <90% (%time with Sp(O) (2) <90) was evaluated.


RESULTS
Six patients (SEV3/TIVA3) had >1% of %time with Sp(O) (2) <90 (S-hypoxemia group), 17 (SEV7/TIVA10) had >0% and <or=1% (M-Hypoxemia group), and 38 (SEV21/TIVA17) had 0% (no-hypoxemia group). There were no statistical differences in age, ASA PS, anesthesia technique, and duration of anesthesia among groups. The S-hypoxemia group had higher body mass index (BMI) and incidence of oxygen supplementation in the PACU than the no-hypoxemia group. No patient had major complications.


CONCLUSIONS
Nocturnal episodic hypoxemia occurs frequently after ambulatory breast cancer surgery. The incidence was not different between SEV and TIVA. Hypoxic patients had a higher BMI and needed oxygen therapy in PACU more frequently.
Shirakami
Gotaro
G
Day Surgery Unit, Kyoto University Hospital, Kyoto, Japan.
Teratani
Yuriko
Y
Fukuda
Kazuhiko
K
D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001943:Breast Neoplasms / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology* / Q000503:physiopathology; D017214:Laryngeal Masks; D008738:Methyl Ethers; D008875:Middle Aged; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D015742:Propofol; D012307:Risk Factors; D000077149:Sevoflurane; D016896:Treatment Outcome
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D010100:Oxygen; D005283:Fentanyl; D015742:Propofol