1. Introduction
ANI, postoperative pain, RP, breast cancer
ADVERSE EVENTS, SECONDARY, BREAST CANCER
These authors contributed equally to this work.Total intravenous anesthesia (TIVA) with remifentanil and propofol (RP) is considered to be an ideal type of general anesthesia (GA) for pediatric and adult patients undergoing medical procedures. However, delivery of an RP mixture by target-controlled infusion (TCI) for GA in surgical procedures has not been described. We investigated the merit of this approach for breast cancer surgery. Eighty-four patients (n = 42 per group) were randomly allocated to propofol and remifentanil either delivered by separate TCI pumps (S group) or in an RP mixture by a single TCI pump (M group). Dosages were adjusted based on the bispectral index (BIS) and the analgesia nociception index (ANI). The primary outcomes were adequate anesthesia (BIS 40–60 and ANI 50–70, respectively), acceptable hemodynamic fluctuations (<30% of baseline) with less frequent TCI pump adjustments, bolus injections of anesthetics, and total consumption of anesthetics during the procedure. The secondary endpoints included time of emergence from anesthesia, patient satisfaction, postoperative pain, rescue with opioids, and adverse events. The characteristics of patients, hemodynamic parameters, BIS and ANI scores, duration of surgery, anesthesia, and emergence were not significantly different between groups. The adjustment frequency of TCI was significantly higher in the S group (3 (range 0–6) vs. 2 (0–6) times; The use of remifentanil is preferable to other opioids for anesthesia when combined with propofol in target-controlled infusion (TCI) regimens for its unique properties: rapid onset of action, precise intra-operative control, and a fast recovery profile [Stewart et al., reported that remifentanil can be mixed with propofol at low concentrations (5 mcg.mLThe analgesia nociception index (ANI) is an index that measures the high-frequency component of heart-rate variability (parasympathetic component of the autonomic response) using the electrocardiogram signal as an input on a scale from 0 (maximum of nociception) to 100 (complete analgesia) [In our institution, even in Taiwan, multiple TCI systems are not popular in each operating room (usually only a single TCI pump available). Considering the limited effective time for RP mixtures and breast cancer surgery typically taking less than 1 h in our hospital when performed by an experienced surgeon, this study aimed to assess the efficacy of the RP mixture prospectively for TCI of propofol’s Ce in patients undergoing breast cancer surgery under BIS and ANI monitoring.