Comparison of MAC with TCI and Sevoflurane Mask Anesthesia for Outpatient Gynecologic Surgery

Background With the advancement of minimally invasive surgical methods, there is a growing need for anesthetic techniques that support rapid, safe, and comfortable recovery in ambulatory care. While sevoflurane inhalation anesthesia is commonly used in outpatient surgery, intravenous methods such as target-controlled infusion (TCI) with propofol and remifentanil have gained popularity. However, direct comparisons of recovery characteristics and respiratory safety between these techniques are limited. Methods In this prospective, randomized controlled study, 51 ASA I–II patients scheduled for outpatient gynecologic surgery were enrolled. Patients were assigned to either a TCI regimen (n = 25) with propofol and remifentanil or an inhalation mask (IM) regimen (n = 26) using sevoflurane and nitrous oxide. Primary endpoints included time to postanesthesia care unit (PACU) discharge readiness (Aldrete score ≥ 9) and patient/surgeon satisfaction. Secondary measures were eye-opening time, anesthesia duration, PACU stay, sedation depth, and adverse events, particularly respiratory depression. Results Baseline characteristics were similar. Time to Aldrete score ≥ 9 did not differ significantly (p = 0.697), but the IM group achieved faster eye opening (p = 0.002). Patient satisfaction was higher in the TCI group (p < 0.001), while surgeon satisfaction favored the IM group (p = 0.035). Respiratory depression occurred more often in the TCI group (28.0% vs. 0%, p = 0.012). Other adverse effects were rare and comparable. Conclusions Sevoflurane anesthesia led to quicker emergence, while TCI provided greater patient satisfaction but increased respiratory risk. Both methods are feasible for outpatient gynecologic procedures, with caution warranted for opioid-based TCI use. Trial registration: Clinical Research Information Service (CRIS), Republic of Korea; KCT0011352. Retrospectively registered on December 19, 2025. https://cris.nih.go.kr