Comparison of Monitored Anesthesia Care with Target-Controlled Infusion and Sevoflurane Mask Anesthesia for Outpatient Gynecologic Surgery: A Single-Center Prospective Randomized Controlled Study

<i>Background and Objectives</i>: Rapid recovery and patient comfort are key goals in ambulatory surgery. Although sevoflurane anesthesia is widely used, target-controlled infusion (TCI) with propofol and remifentanil has gained attention for its potential benefits. However, comparative data regarding recovery profiles and respiratory safety remain limited. <i>Materials and Methods</i>: In this prospective randomized controlled trial, 51 ASA I-II patients undergoing outpatient gynecologic surgery were assigned to either a TCI group (<i>n</i> = 25) or an inhalation mask (IM) group using sevoflurane and nitrous oxide (<i>n</i> = 26). Primary outcomes included time to postanesthesia care unit (PACU) discharge readiness and patient and surgeon satisfaction. Secondary outcomes included eye-opening time, anesthesia duration, PACU stay, and respiratory adverse events. <i>Results</i>: Time to Aldrete score ≥9 did not differ significantly between groups (<i>p</i> = 0.697). The IM group demonstrated faster eye opening (<i>p</i> = 0.002), while patient satisfaction was higher in the TCI group (<i>p</i> < 0.001). Surgeon satisfaction favored the IM group (<i>p</i> = 0.035). Respiratory depression occurred more frequently in the TCI group (28.0% vs. 0%, <i>p</i> = 0.012). <i>Conclusions</i>: Sevoflurane anesthesia allowed faster emergence, whereas TCI provided greater patient satisfaction but increased respiratory risk. Both techniques are feasible for ambulatory gynecologic surgery when appropriately selected. Trial registration: This study was retrospectively registered at the Clinical Research Information Service (CRIS), Republic of Korea (KCT0011352).