A Comparison Of Anesthesia Maintained By Propofol Target Controlled Infusion With Isoflurane Inhalation On The Satisfaction Of Postoperative Patients In Breast Cancer

Objective: In analyzing whether an anesthetic drug is superior to another, the most important thing is whether or not its ultimate effects on patients, hospitals and profit useful.The relationship and definition between the drug and economic interests are very difficult to explain, we can analysis only from the perspective of patients and hospitals. What they are most concerned about is that postoperative mortality, but in the current conditions, perioperative mortality rate very low, it is almost impossible as the criterion for the choice of anesthetic drugs.As a judge criterion, the incidence of postoperative complications is very importment,too. In investigation and study, it has the substitution effect to satisfaction of the patients. Foreign reported in the literature, the reasons of patients fearing general anesthesia are as follows:the first is postoperative delayed recovery time, followed by postoperative nausea and vomiting(PONV), postoperative agitation and postoperative pain, and so on. Which affecting the incidence of postoperative complications, there are three main factors: patient's, anesthetic and surgical factors. The purpose of this study is to evaluate propofol TCI total intravenous anesthesia with isoflurane inhalation anesthesia on the incidence of postoperative complications and severity of the impact in the conditions of the patient factors and surgical factors relatively fixed.Methods: Twenty patients for modified radical mastectomy were randomized divided into two groups:the propofol TCI group(Group P) and the isoflurane-maintance group (Group I), with 10 cases each .All patients were induced with midazolam - vecuronium - remifentanil– etomidate,with LMA inserted after induction to controlled ventilation.In Group P,TCI propofol was maintained until incision closure with target concentration 2-4μg / ml.In Group I, isoflurane (oxygen flow 1 L / min) was maintained until incision closure with end-tidal concentration of 1-3%, and anesthetic gas absorber was used then. Remifentanil continuously intravenous infusion until to the end of operation with 0.05-0.1μg / (kg.min). Flurbiprofen (1 mg/kg)was intravenous injected for using of postoperative analgesia. Following index were recored in both groups: HR, MAP and SPO2 before induction of anesthesia, immediately after LMA insertion, incision, 5 min after incision, after incision closure,eye-opening, LMA removal immediately , leaving the operating room ; the operative time,the time from discontinuation of inhalation anesthetic to eye-opening, to LMA removal and to Aldrete score of nine points; postoperative 2 h, 6h, 12h, 24h score of nausea and vomiting, pain score;the incidence of postoperative agitation and the severty's assessment.Results: Between propofol TCI groups and isoflurane Groups, there are no statistically significant difference in the patients'general cond- itations, MAP and SPO2 during the operation,the recovery time, the PONV scores and the postoperative 24h's VAS scores. During the recovery time, propofol TCI groups'HR lower than isoflurane Groups', there were statistically significant differences between the two groups.Conclusion: There are no statistically significant difference between propofol TCI TIVA and isoflurane inhalation anesthesia about the patients'recovery and postoperative complications in the conditions that the LMA and remifentanil are used to the patients for modified radical mastectomy.