Anesthesia studies should include costs.

INTRODUCTION: The importance of breast surgeries can be observed in the current context in which the increasingly growing number of restorative procedures and plastic surgeries in Brazil. To perform the various surgeries, several anesthesic techniques are used as general anesthesia, thoracic epidural or more recently, thoracic paravertebral block. Thus, it is essential to know about the safety of each anesthesic technique in these surgeries, which led to the realization of this review. OBJECTIVES: Analyze the benefits and complications of general anesthesia, thoracic epidural and paravertebral block in breast surgery. MATERIAL AND METHODS: We used the keywords “breast surgery general anesthesia”, “breast surgery thoracic epidural anesthesia” and “breast surgery thoracic paravertebral block” to draw up this systematic review of literature. The databases searched were PubMed, SciELO, MEDLINE, LILACS and Cochrane Library. The articles were selected using the following inclusion criteria: Medical journals from 1995 to 2011, in the languages English, Spanish and Portuguese, in order of relevance and study design of randomized controlled trials and cohort. The pre-selected articles were assessed individually by two reviewers and evaluated on their methodological quality by the Jadad scale, and were scored according to the criteria of randomization, blinding and accountability of all patients, including withdrawals. RESULTS: Fifteen articles were included in this review. The benefits of thoracic epidural anesthesia were better quality of postoperative analgesia, lower length hospitalization and the consumption of analgesics was also lower than general anesthesia. Hypotension and bradycardia were reported as possible complications. General anesthesia was more frequent reported with nausea, hypertension and vomiting. When associated with thoracic paravertebral block, promoted analgesia and anesthesia with lower complications than when applied as single anesthesic technique, as lower intensity of postoperative pain, less nausea and vomiting and less anesthesic recovery time. There are no studies that prove the effectiveness of paravertebral block when used without general anesthesia association. CONCLUSION: The epidural technique, despite its complications, remains the best option for regional block, and with general anesthesia, are the most commonly anesthesic techniques performed in breast surgeries, since evidence is lacking to prove the effectiveness of using thoracic paravertebral block in a patient who is not sedated. More research on the effectiveness of such techniques not associated with general anesthesia should be performed.

Objective To investigate the effect of general anesthesia combined with paravertebral block for thoracic surgery.Methods Retrospectively analyzed 30 patients (group P) under general anesthesia combined with paravertebral block for accepting radical resection of cardia carcinoma and 30 patients (group G) undergoing same surgery with only general anesthesia in the same period.Before general anesthesia,patients in group P received paravertebral nerve block in operating side with 20 ml 0.375％ ropivacaine injected into paravertebral space and catheters were left after injection.The consumption of anesthetic drugs,anesthetic management,anesthetic recovering,postoperative visual analog scale(VAS) at rest and when coughing in both groups were recorded.Satisfaction of anesthesia was recorded 24 h postoperatively.Results The process of anesthesia and operation went well in all groups.The mean consumption of sulfentanyl and sevoflurane in group P was less than that in group G [(5±4) μg vs (26±4) μg](P＜0.01).Recovery time in group P was shorter than that in group G [(45±18) min vs (100±20) min] (P＜0.01).Mean V AS scores when coughing were significantly decreased in group P (P＜0.01).The postoperative fentanyl consumption of patients in group P was significantly less than that in group G [(0.11±0.12) mg vs (0.42±0.11) mg](P＜0.01).Conclusions Using landmark technique in paravertebral block combined with general anesthesia for thoracic surgeries may simplify the anesthesia management and decrease anesthetics consumption in favor of anesthesia recovery and postoperative analgesia. Key words: Balanced anesthesia; Paravertebral block; Thoracic surgery

Objective To evaluate the effects of propofol and sevoflurane anesthesia on cognitive function and amyloid beta protein (Aβ) deposition in hippocampi of aged mice. Methods Thirty-six SAMP8 mice, aged 6 months, weighing 29-32 g, were randomly assigned into 4 groups (n=9 each) using a random number table: control group (group C) , propofol anesthesia group (group P) , sevoflurane anesthesia group (group S) and propofol plus sevoflurane anesthesia group (group PS) . In group P, propofol 140 mg/kg was injected intraperitoneally, when righting reflex occurred, additional propofol 70 mg/kg was given, and when it occurred again, additional propofol 40 mg/kg was given.Group S continuously inhaled 1% sevoflurane for 120 min.Group PS continuously inhaled 2% sevoflurane for 120 min, and when righting reflex occurred, additional propofol 40 mg/kg was given.Anesthesia was maintained for 120 min in P, S and PS groups.Before anesthesia and at 7, 14 and 28 days after anesthesia, Morris water maze test was performed, and the escape latency was recorded.Hippocampi were obtained to determine the expression of Aβ using immuno-histochemistry. Results Compared with group C, the escape latency was significantly prolonged at 7 days after anesthesia, and the expression of Aβ was up-regulated at 7, 14 and 28 days after anesthesia in group S, and no significant change was found in the parameters mentioned above in P and PS groups.Compared with the value at 7 days after anesthesia, the expression of Aβ was significantly down-regulated at 14 and 28 days after anesthesia in group S, and no significant change was found in the expression of Aβ at 14 and 28 days after anesthesia in C, P and PS groups. Conclusion Although sevoflurane anesthesia promotes Aβ deposition in hippocampi, it only causes short-term cognitive dysfunction, however, anesthesia with propofol or with propofol in combination with sevoflurane produces no influence in aged mice. Key words: Anesthetics, inhalation; Propofol; Amyloid beta-protein; Hippocampus; Cognition; Aged

Objective To explore the narcotic effects of different puncture in combined spinal-epidural block anesthesia for urological Surgery.Methods 108 cases of urologic surgery were selected.The patients were randomly divided into the two groups according to digital meter (each group had 54 cases).Both groups were treated with combined spinal-epidural anesthesia.The anesthesia puncture of group A were in lumbar intervertebral 2-3,the anesthesia puncture of Group b were in lumbar intervertebral 3-4.The respects of the two groups were observed and compared such as blood pressure before and after anesthesia,initial anesthesia plane,the time the drug arrived to the sixth thoracic vertebrae,additional lidocaine dose during the operations anesthesia quality rate and anesthesia side effects.Resuits The blood pressures of the patients of group A were significantly lower than those of group B 5 minutes after anesthesia (t =2.73,2.29,2.29,all P ＜ 0.05),the incidence of adverse reactions of Group B such as nausea,vomiting,low blood pressure,difficulty in breathing (24.1％,14.8％),was significantly lower than incidence of group A (44.4％,and 13.0％,x2 =4.97,5.07,4.86,all P ＜ 0.05) the set of initial plane of anesthesia of group a was significantly higher than that of group B (t =2.91,P ＜ 0.05),the time the drug arriving to the sixth thoracic vertebrae,of group A was significantly shorter than group B (t =2.42,P ＜ 0.05) the amounts of additional lidocaine dose of Group A during the operations were significantly less than group A (t =2.61,P ＜ 0.05).There were no significant differences in the anesthesia quality rate (P ＞ 0.05).Conclusion Selecting L3-4 puncture points in combined spinalepidural anesthesia can significantly reduce incidence of adverse reactions such as nausea,vomiting,low blood pressure and difficulty in breathing compared with selecting L2-3 puncture during urology surgery procedure.It can also reduce pain during operations.Though there are significant differences in initial level of anesthesia,the time the drug arrive to the sixth thoracic vertebrae and additional lidocaine doses,leading no effects on superior rate of anesthesia.Thus the clinical significance is not very big. Key words: Combined spinal-epidural anesthesia; Urologic surgery; Lumbar spine; Puncture

Objective To analyze the value of the waveform curve and quantitative value of end-respiratory carbon dioxide partial pressure (PETCO2) in resuscitation monitoring of patients with general anesthesia. Methods One hundred and forty-two patients who performed operation under general anesthesia and entered into the anesthesia recovery room in Zhejiang Xin′an International Hospital from April 2019 to September 2019 were selected. According to the method of random number table, all the 142 cases were divided into control group and observation group, with 71 cases in each group. Routine monitoring during general anaesthesia resuscitation such as blood pressure (BP), respiratory frequency (RR), blood oxygen saturation (SpO2), arterial partial pressure of carbon dioxide (PaCO2) was performed in the control group. On this basis, changes in PETCO2 waveform curve and quantitative value was continuously monitored in the observation group.The abnormal events rate, checkout time, anesthesia resuscitation time and residence time in the anesthesia recovery room of two groups during anesthesia resuscitation were recorded. Besides, the relationship between PETCO2 and PaCO2 was analyzed. Results The levels of RR, BP, SpO2, PaO2 in both groups were in the normal range during general anesthesia resuscitation, and PETCO2 in the observation group was also in the normal range. During general anesthesia resuscitation, the abnormal events rate in the observation group was was higher than that in the control group: 12.68%(9/71) vs. 7.04%(5/71); besides, the checkout time of abnormal events, anesthesia resuscitation time and residence time in the anesthesia recovery room in the observation group were shorter than those in the control group: (1.61 ± 0.52) min vs. (2.11 ± 0.69) min, (35.98 ± 10.66) min vs. (46.75 ± 15.03) min and (62.52 ± 19.63) min vs. (76.97 ± 15.41) min, there were significant differences (P<0.05). PETCO2 was negatively correlated with SpO2 (r=-0.335, P=0.004), while PETCO2 was positively correlated with PaCO2 (r=0.751, P<0.001). Conclusions Monitoring PETCO2 of patients during general anesthesia resuscitation can improve the detection rate and timeliness of abnormal events, promote the recovery of anesthesia and help to reduce the occurrence of adverse events. Key words: Anesthesia resuscitation; Recovery; End-respiratory carbon dioxide partial pressure; Arterial partial pressure of carbon dioxide

Objective To analyze the influence of different anesthesia methods on the stress response and hemodynamic of elderly patients undergoing laparoscopic cholecystectomy (LC).Methods Fifty-eight elderly patients who needed LC were selected and divided by random digits table method into GAEA group received general anesthesia combined with epidural anesthesia and GA group received general anesthesia with 29 cases each.The stress response and changes of hemodynamic were observed.Results Blood pressure and heart rate (HR) were elevated during pneumoperitoneum in both groups.Blood pressure and HR returned to normal at 30 minutes after pneumoperitoneum in GAEA group,which were recovered more slowly in GA group.There was no significant difference in systolic blood pressure (SBP),diastolic blood pressure (DBP),HR between two groups before and after anesthesia (P＞0.05).SBP,DBP,HR of GAEA group were ( 123.8 ± 25.9) mm Hg ( 1 mm Hg =0.133 kPa),(85.9 ± 8.4) mm Hg,(83.2 ± 7.4) times/min during pneumoperitoneum,respectively,(118.2 ±21.1) mm Hg,(84.4 ±8.3) mm Hg,(82.8 ±7.5)times/min at 10 min after pneumoperitoneum,( 114.9 ± 20.7) mm Hg,(80.2 ± 7.6) mm Hg,(78.5 ± 10.4)times/min at 30 min after pneumoperitoneum.SBP,DBP,HR of GA group were (138.3 ±26.7) mm Hg,(91.2 ± 8.8) mm Hg,(89.3 ± 10.1 ) times/min during pneumoperitoneum,( 130.3 ± 21.3) mm Hg,(89.2 ±8.6) mm Hg,(88.2 ± 9.7) times/min at 10 min after pneumoperitoneum,( 126.2 ± 20.7) mm Hg,(85.2 ±8.4) mm Hg,(84.9 ± 9.6 ) times/min at 30 min after pneumoperitoneum,respectively.SBP,DBP,HR during pneumoperitoneum,at 10 min and 30 min after pneumoperitoneum in two groups had significant differences (P ＜0.05).The anesthesia onset time in GAEA group was (73.2 ±24.9) s,and the awake time after operation was (31.6 ± 10.2) min,while those in GA group were (78.1 ± 22.4) s and (35.9 ± 14.3) min.The anesthesia onset time and awake time after operation in GAEA group were shorter than those in GA group,but had no significant difference (P＞ 0.05 ).Postoperative visual analogue score of GAEA group [ ( 13.4 ± 8.2)scores] was obviously lower than that of GA group [(26.3 ± 10.1) scores] (P ＜0.05).The incidence of adverse reactions between GAEA group [27.59％(8/29)] and GA group [6.90％(2/29)] had statistical difference (P ＜ 0.05).Conclusions Compared with general anesthesia,general anesthesia combined with epidural anesthesia during LC for elderly patients can reduce the occurrence of intraoperative stress responses and have more steady hemodynamic,better anesthetic effect and faster recovery.But it may cause the incidence of nausea,headache and other postoperative adverse reactions increase. Key words: Cholecystectomy,laparoscopic; Anesthesia,general; Anesthesia,epidural; Aged

Comparison of the recovery from isoflurane anesthesia with or without fentanyl infusion in patients undergoing elective supratentorial craniotomy.

Wide variability exists in the amount of regional anesthesia practice to which residents are exposed during training. The number of attempts at various blocks before a trainee becomes proficient at performing these regional anesthetic techniques is not known. This study addresses the question: What is the minimum number of blocks a resident must perform to reach consistency during training in these techniques? Every regional anesthetic technique attempted by all beginning CA-1 anesthesiology residents (n = 7) during their first 6 months of training (July 1993 to December 1993) were recorded on a daily basis. Nonregional anesthetic techniques attempted were recorded for comparison. The objective measures used to define the degree of success were obtaining cerebrospinal fluid during attempted spinal anesthesia, subsequent anesthetic block during epidural placement, and detection of end-tidal carbon dioxide for endotracheal intubation. An average of 77 +/- 9 epidural anesthetics, 44 +/- 6 spinal anesthetics, and 86 +/- 13 endotracheal intubations were attempted during the 6 months of training. The learning curves for each technique are of similar shape. Residents show significant (P < .05) improvement over baseline after 20 spinal and 25 epidural anesthetics, but a 90% success rate is not reached and maintained until 45 spinal and 60 epidural anesthetics are performed. Approximately 20-25 procedures each are necessary before improvement in the techniques of spinal and epidural anesthesia is demonstrated by residents in training. If a 90% success rate is desired, 45 and 60 attempts at spinal and epidural anesthesia, respectively, may be necessary.

Objective To evaluate the clinical effect of the anterior middle superior alveolar block (AMSA) injection using the computer-controlled local anesthetic delivery system for maxillary scaling and root planing. Methods Forty-five adult patients with periodontal disease were selected for the research. The maxillary region of each patient was divided into left part and right part to receive two different anesthetic techniques randomly. The local anesthesia was performed using 4% articaine with either AMSA or with the conventional infiltration technique. Pain response was recorded and evaluated with a standardized visual analogue scale (VAS) ranging from 0-10. The anesthetic efficacy, duration and side effect of both anesthetic techniques were evaluated with questionnaire and clinical assessment. The dates were analyzed by t-test, Chi-square test, Fisher exact test and Wilcoxon signed-rank test. Results The VAS was 1.86 ± 0.76 in the test group and 3.18 ± 1.05 in the control group, the test group showed significantly lower VAS scores compared to the control group (t = -9.487, P<0.001) . In the evaluation of efficacy and safety, no statistically significant differences were found. The achievement ratio was 82.2% in the test group and 93.3% in the control group (χ2 = 1.6571, P = 0.198) . The complication ratio was 2.2% in the test group and 0 in the control group (P = 0.5) . No patient reported facial anesthesia in the test group while all patients in the control group reported varying degrees of facial anesthesia. The anesthetic duration was ranged from 30 to 90 min in the test group and 61 to 120 min in the 83.3% subjects of the control group. The results showed higher satisfaction (Z = -8.857, P<0.001) and shorter duration (Z = -5.748, P<0.001) in the test group compared to the control group. Conclusion The AMSA injection delivered with the computer-controlled local anesthetic delivery system was found to be more comfortable and acceptable for patients than conventional local infiltration technique, and thus to be a promising anesthetic technique for maxillary scaling and root planing. Key words: Nerve block, superior alveolar nerve; Infiltration anesthesia, local; Dental scaling; Root planning; Computer-controlled local anesthetic delivery system

Objective To investigate the use of two kinds of anaesthesia maintenance methods, namely total venous and total inhalation, which are more suitable for laparoscopic repair of esophageal hiatal hernia. Methods The medical records of 133 patients were retrospectively analyzed and divided into two groups according to the maintenance of anesthesia: sevoflurane group (Sev group) (n=51) and total intravenous anesthesia group (TIVA group) (n=82). Comparing the 6 intraoperative time points (T1: before induction of anesthesia, T2: after induction of anesthesia, T3: 30 minutes after surgery, T4: 60 minutes after surgery, T5: 90 minutes after surgery, T6: when PACU is delivered) heart rate (HR) and mean arterial blood pressure (MAP), intraoperative and postoperative adverse reactions, postoperative awake time, PACU retention time, venting time, postoperative dose of dizocine in the anesthesia Postanesthesia care unit (PACU), The VAS scores at the last 5 time points (wake-up, at the PACU, 8 hours postoperatively, 12 hours postoperatively, 24 hours postoperatively). Results The MAP and HR were significantly lower in the TIVA group than in the Sev group at each time point during and after surgery (P 0.05), but the incidence of adverse events and postoperative nausea and vomiting (PONV) were significantly higher in the Sev group than in the TIVA group, and the PACU stay and exhaust time were longer. The VAS score was higher at 5 postoperative days, and the dose of dizocine was more (P<0.05). Conclusion It is better to maintain the intravenous anesthesia during laparoscopic repair of esophageal hiatus than to maintain anesthesia. Key words: Hernia, hiatal; Anaesthesia maintenance; Total intravenous anesthesia; Anesthesia, inhalation

Aim To measure patients’ satisfaction with anaesthesia care and use it as a tool to provide a feedback on the quality of practice of anesthesia in our centre. To examine the validity of this tool as a means of evaluating anaesthetic care. Study design This is a prospective questionnaire based study. They were standardised postoperative face to-face interviews with open-and close-ended questions. Patients were chosen by simple random sampling. The questionnaires were administered on the second postoperative day. The questionnaire was subdivided into a set of questions. Anaesthesia specific rating of preoperative visit, preparation, and anaesthetic administered were assessed on a 3-point scale. A 5-point scale was used to assess the overall rating of anaesthetic care. Results A total of 43 patients were interviewed. They were 17 males and 26 females. Anaesthesia specific rating showed that 90.1% of patients were satisfied with the preoperative visit, 95.3% with preparation, and 74.4% with anaesthesia. Study design was rated 40/60 using Patient Satisfaction with Anesthesia Care–Analysis Tool (PSACAT). Conclusion We conclude that the anaesthetic service offered in our centre is reasonably tolerated and acceptable to patients. Key words: Patient satisfaction, Anaesthesia, Enugu

Clinical management of maggot wounds in Asiatic Black Bear (Ursus thibetanus)‎Like most other species, the Asiatic black bear is vulnerable to a wide range of diseases, ‎including infection, inflammation, parasitic infestation, and degenerative disease. The study ‎reported here the surgical and conservative management of maggot wounds, including ‎anesthetic protocol and postoperative care in Himalayan Black Bear (Ursus ‎thibetanus). Anesthesia was performed successfully by administering Xylazine and ‎Ketamineintramuscularly (IM) by remote injection using a tranquilizing gun with a 10CC anesthetic ‎dart. The clinical evaluation of the animalshowed an induction time of 4.5 minutes, duration of ‎anesthesia was 72.0 minutes, and recovery time of 38.0 minutes. All the physiological ‎parameters were within normal limits.‎Key Words: Myiasis, anesthesia, Physiological parameters Key Words: Myiasis, anesthesia, Physiological parameters Key Words: Myiasis, anesthesia, Physiological parametersKey Words: Myiasis, anesthesia, Physiological parameters, Key Words: Myiasis, anesthesia, Physiological parameters, Key Words: Myiasis, anesthesia, Physiological parameters, Key Words: Myiasis, anesthesia, Physiological parameters

Objective The objective of the study was to compare the effect of spinal and general anesthesia in return of gastrointestinal motility in an elective cesarean section (CS). Background CS is a common major hospital surgical procedure performed nowadays. One of the most common postoperative complications is postoperative gastrointestinal paralysis (ileus) that must be minimized due to its possible serious consequences. Patients and methods One hunderd and forty pregnant women who were admitted for CS and fulfilled the criteria of the study population were enlisted in this prospective, controlled study and were then assigned to either group A or B. Group A included 70 patients for general anesthesia, while group B included 70 patients for spinal anesthesia. Results This study results were shown to have a statistically significant effect of spinal anesthesia versus general anesthesia in terms of shorter mean time interval to normal intestinal sound, passage of flatus, first motion, and discharge from hospital. Also, the study showed beneficial effect of spinal anesthesia versus general anesthesia in terms of less use of opioids, less use of NSAIDs, less incidence of distension, and less incidence of ileus. Conclusion Spinal anesthesia results in a quicker return of bowel activity after a CS, decreased hospital stay, and less use of postoperative opioids than general anesthesia.

Objective To compare the effectiveness of Remifentanil versus Fentanyl anesthesia applied in urological laparoscopic surgery. Methods A total of 78 patients undergoing urologic endoscopy in our hospital from July 2016 to December 2017 were recruited, and randomly divided into the Remifentanil group(n=39)with Remifentanil anesthesia and the Fentanyl group(n=39)with Fentanyl anesthesia.The changes in mean arterial pressure and heart rate, anesthetic effects and adverse reaction rates during anesthesia were compared between the two groups. Results The reduction of mean arterial pressure of premedication/induction of anesthesia(T0)was more pronounced in the Fentanyl group than in the Remifentanil group(t=2.855, P=0.003), but the heart rate was lower in the Remifentanil group than in the Fentanyl group(t=4.405, P=0.000). The changes of heart rate and mean arterial pressure were more significant in the Fentanyl group than in Remifentanil group immediately after tracheal intubation(T1), during incision of skin(T2), immediately after suture of the abdomen(T3)and immediately after removal of the tracheal tube(T4)(P<0.05). The spontaneous respiration recovery time, blinking time, extubation time, force recovery time and recovery time were shorter in the Remifentanil group than in the Fentanyl group(P<0.05). The incidence of anesthetic adverse reactions was lower in the Remifentanil group than in the Fentanyl group(10.3%, 4/39 vs.28.2%, 11/39, χ2=4.044, P=0.044). Conclusions Both Remifentanil and Fentanyl groups have good anesthetic effects in urological anesthesia, but Remifentanil has less fluctuations of perioperative blood pressure and heart rate, has higher recovery quality and less anesthetic adverse reactions.Therefore, Remifentanil anesthesia is worthy of promotion. Key words: Analyesics, opioid; Endoscopic surgery

Objective To observe and compare the control effect of monitored anesthesia care on stress reaction of operation under local anesthesia. Methods Fourty-five patients who undered ophthalmology and otolaryngology operation and ASAⅠorⅡclass, aged 20-55 years were enrolled. They were randomly divided into 3 groups: monitored anesthesia care(M group), general anesthesia (G group), and local anesthesia (L group). All of three groups were performed local nerve block anesthesia. Mean arterial blood pressure (MAP)、heart rate (HR) were recorded at enter room (T1), the strongest operation stimulation (T2), the end of operation (T3). At the same time,the levels of blood glucose,plasma cortisol (Cor) were assayed. The scores of state of anxiety (S-AI) before operation and after operation in two groups were compared. Results The levels of MAP and Cor at T2, T3 and HR at T2 in G group and M group were significantly lower than those at T1: (68.1±8.2), (78.8±12.8) mmHg (1 mmHg=0.133 kPa) vs. (95.7±11.3) mmHg; (80.8±11.7), (86.2±9.0) mmHg vs. (94.7±11.5) mmHg; (207.0±71.8), (135.2±60.9) nmol/L vs. (336.7±121.4) nmol/L; (220.8±113.2),(190.4±149.0) nmol/L vs. (347.8±154.6) nmol/L; (68.1±10.6) beats/min vs. (79.9±14.2) beats/min; (70.3±10.1) beats/min vs. (80.6±12.2) beats/min, there were significant differences (P<0.05). The level of blood glucose at T3 was significantly lower than that at T1 in G group [ (4.9±0.7) mmol/L vs. (5.5±0.6) mmol/L], there was significant difference (P<0.05) . The levels of MAP, Cor at T2 in G group and M group, at T3 in G group were significantly lower than those at the same point in L group: [ (68.1±8.2) , (80.8±11.7) mmHg vs. (93.4±12.5) mmHg, (207.0±71.8) , (220.8±113.2) nmol/L vs. (367.1±157.3) nmol/L, (78.8±12.8) mmHg vs. (92.6±15.3) mmHg, (135.2±60.7) nmol/L vs. (311.9±165.6) nmol/L], there were significant differences (P<0.05) . The scores of S-AI at postoperative in G group and L group were significantly lower than that at preoperative: (31.5±6.6) scores vs. (44.3±15.0) scores, (35.2±11.5) scores vs. (49.3±14.2) scores, there were significant differences (P<0.05). Conclusion Monitored anesthesia care can alleviate stress reaction in operation with local anesthesia,while its effect is similar with general nesthesia. Key words: Anesthesia, general; Intraoperative period; Stress reaction