title: Comparison of general anesthesia and monitored anesthesia care in patients undergoing breast cancer surgery using a combination of ultrasound-guided thoracic paravertebral block and local infiltration anesthesia: a retrospective study.
abstract: OBJECTIVE
  The aim of this study was to compare post-anesthesia recovery time and the incidence of hypotension episodes during anesthesia in breast cancer surgery between general anesthesia (GA) and monitored anesthesia care (MAC) retrospectively. Both techniques were combined with ultrasound-guided paravertebral block (US-PVB) and local infiltration anesthesia (LIA).
  
  
  METHODS
  We reviewed the medical records of patients who received US-PVB for breast cancer surgery retrospectively and divided them into two groups based on the method of anesthetic management. In the GA group, anesthesia was induced using propofol and maintained by sevoflurane inhalation via a laryngeal mask airway after US-PVB was performed under sedation with midazolam. In the MAC group, US-PVB and surgery were carried out under sedation with propofol and remifentanil and supplemental oxygen through a facemask. All patients in both groups breathed spontaneously and received US-PVB and LIA with 0.5 % ropivacaine and diclofenac suppository for pain relief.
  
  
  RESULTS
  Times from post-anesthesia care unit admission to fluid intake (mean ± SD; 79 ± 34 vs. 99 ± 33 min, P = 0.034) and gait (77 ± 45 vs. 109 ± 45 min, P = 0.013) were significantly shorter in the MAC group (n = 29) than in the GA group (n = 29). Average systolic blood pressure (SBP) was significantly lower (89 ± 11 vs. 99 ± 16 mmHg, P = 0.011) and the incidence of hypotension (SBP < 70 mmHg) was higher (52 vs. 21 %, P = 0.014) in the GA group than in the MAC group during anesthesia.
  
  
  CONCLUSIONS
  MAC with US-PVB and LIA exhibited faster post-anesthesia recovery and a lower incidence of hypotension episodes during anesthesia than GA with US-PVB and LIA in breast cancer surgery.
authors.affiliation: Day Surgery Unit, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan. masami@kb3.so-net.ne.jp.
authors.forename: Masami
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Anesthesia and Pain Medicine, Kagawa University Hospital, Kagawa, 761-0793, Japan.
authors.forename: Gotaro
authors.initials: G
authors.lastname: Shirakami
authors.affiliation: Department of Anesthesia, Kyoto University Hospital, Kyoto, 606-8507, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods*; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods; D008738:Methyl Ethers / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D015742:Propofol / Q000008:administration & dosage; D012189:Retrospective Studies; D000077212:Ropivacaine; D000077149:Sevoflurane
chemical_list: D000577:Amides; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077212:Ropivacaine; D008874:Midazolam; D015742:Propofol
keywords: Breast cancer surgery; Monitored anesthesia care; Perioperative hemodynamics; Post-anesthesia recovery; Ultrasound-guided paravertebral block