Comparison of Monitored Anesthesia Care with Target-Controlled Infusion and Sevoflurane Mask Anesthesia for Outpatient Gynecologic Surgery: A Single-Center Prospective Randomized Controlled Study
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsReview
Comparison of Monitored Anesthesia Care with Target-Con-2 trolled Infusion and Sevoflurane Mask Anesthesia for Outpatient Gynecologic Surgery: A Single-Center Prospective Randomized Controlled Study
Comparison of Monitored Anesthesia Care with Target-Controlled Infusion and Sevoflurane Mask Anesthesia for Outpatient Gynecologic Surgery: A Single-Center Prospective Randomized Controlled Study
This manuscript presents a clinically relevant and interesting comparison of two anesthetic techniques used in outpatient gynecologic procedures.
The abstract is clearly written and appropriately summarizes the key aspects and main findings of the study.
The introduction is concise, well structured, and of appropriate length. It provides sufficient background information and adequately introduces the research problem. The objective of the study is clearly defined.
The methodology is well described, with clearly stated inclusion and exclusion criteria and an appropriate randomization process. The study design is adequately presented, and the statistical methods used are appropriate for the type of data analyzed.
The results are clearly presented, easy to follow, and well organized.
The discussion is balanced and of appropriate length. The authors appropriately interpret their findings and compare them with previously published studies.
The conclusion is clear, concise, and consistent with the presented results, without overstating the implications.
The reference list is adequate and relevant. However, I would suggest reconsidering references 6, 7, 11, and 15, as they could potentially be replaced with more recent literature to further strengthen the manuscript.
Comments on the Quality of English LanguageHowever, I would suggest that the English language be carefully reviewed by a professional language editor in order to correct minor grammatical and stylistic issues and further improve the overall clarity and quality of the manuscript.
Author Response
Comment 1. The reference list is adequate and relevant. However, I would suggest reconsidering references 6, 7, 11, and 15, as they could potentially be replaced with more recent literature to further strengthen the manuscript.
Response: We agree with the reviewer’s assessment. References [6, 7, 11, 15] have been updated to include recent clinical guidelines and pharmacokinetic studies published within the last 5–10 years.
Comment 2.However, I would suggest that the English language be carefully reviewed by a professional language editor in order to correct minor grammatical and stylistic issues and further improve the overall clarity and quality of the manuscript.
Response: The manuscript has undergone thorough professional English editing. Furthermore, we have expanded the Results and Discussion sections to provide a more comprehensive report of our findings.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Comments and Suggestions for AuthorsHello, dear authors!
This study compares two methods of anesthesia in outpatient gynecological surgery: targeted propofol-remifentanil infusion and traditional sevoflurane inhalation mask anesthesia. Overall, the work represents a relevant area of ​​knowledge needed to improve the quality of anesthesia care for patients.
However, despite the obvious advantages, I noticed several points in the text that I would like to bring to the authors' attention.
1. Most of the references in the list are out of date. Using studies from 1995-2008 to describe current anesthesia standards or pharmacokinetics (especially remifentanil, Michelsen, 1996) is unacceptable. You need to update your reference list and, as a result, correct and supplement the "Relevance" and "Discussion" sections.
2. You indicated a 30% potential loss ("dropout rate") for the final sample of 52 participants. For outpatient surgical interventions, such a percentage is extremely high and economically unjustified, so it would be advisable to revise the description or include this in the limitations.
3. In Table 4. Adverse Events, note that the IM group indicates 0 (7.7%). If there are no events (0), then the percentage should be 0%, not 7.7%. Other adverse events (nausea, agitation) should be 2 (7.7%).
Author Response
Comment 1. Most of the references in the list are out of date. Using studies from 1995-2008 to describe current anesthesia standards or pharmacokinetics (especially remifentanil, Michelsen, 1996) is unacceptable. You need to update your reference list and, as a result, correct and supplement the "Relevance" and "Discussion" sections.
Response: As suggested, we have replaced older references with recent high-impact literature. Specifically, for remifentanil and propofol pharmacology, we now cite the Eleveld et al. (2018) model.
Comment 2. You indicated a 30% potential loss ("dropout rate") for the final sample of 52 participants. For outpatient surgical interventions, such a percentage is extremely high and economically unjustified, so it would be advisable to revise the description or include this in the limitations.
Response: We have added a detailed explanation in both the Statistical Analysis and Limitations sections. The 30% dropout rate was a conservative estimate chosen to account for the high unpredictability of outpatient gynecologic surgery, such as sudden schedule changes or procedure conversions.
Comment 3. In Table 4. Adverse Events, note that the IM group indicates 0 (7.7%). If there are no events (0), then the percentage should be 0%, not 7.7%. Other adverse events (nausea, agitation) should be 2 (7.7%).
Response: We sincerely apologize for the typographical error in Table 4. We have corrected the number of "Other adverse events" in Group M from 0 to 2 (7.7%) to accurately match the percentage and the underlying data.
Author Response File: Author Response.docx
