Propofol or Thiopental sodium in patients undergoing reproductive assisted technologies: Differences in hemodynamic recovery and outcome of oocyte retrieval: A randomized clinical trial (original) (raw)
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Analgesia and anesthesia for assisted reproductive technologies
International Journal of Gynecology & Obstetrics, 2009
Background: Oocyte retrieval for in vitro fertilization (IVF) is one of the most common minor surgical procedures. Objectives: To give an update on anesthesia practices used currently in the United States and Europe in assisted reproductive technology, and discuss the safety or the potential risks for oocyte and embryo quality. Search strategy: Electronic search of MEDLINE for literature published between 1972 and 2008. Selection criteria: Relevant studies on the types of anesthesia used for oocyte retrieval and the impact on oocyte and embryo quality. Data collection and analysis: Relevant studies were reviewed by the authors and the ones of significant scientific merit, based on methodology, were included. Main results: Types of anesthesia that may be used for transvaginal follicular aspiration and oocyte retrieval include: general anesthesia, neuraxial anesthesia, conscious sedation, injection of local anesthetic agents into the cervix or the vaginal wall, or any combination of the above. Conscious sedation is most commonly used in IVF because it is relatively safe and does not require the presence of an anesthesiologist when opioids or benzodiazepines are used. Propofol is the preferred anesthetic agent, but should be used by specially trained personnel. Conclusion: Conscious sedation is the most popular method of anesthesia used in IVF. Presently, a combination of propofol, fentanyl, and midazolam is used frequently. It is easy to administer in cooperative and motivated patients and is safe in healthy individuals; it has a relatively low risk for adverse effects on oocyte and embryo quality and pregnancy rates.
2011
Background We conducted this study to compare the outcome of assisted reproductive technology (ART) procedures and recovery from anesthesia in women who received opioid analgesia with remifentanil versus fentanyl. Materials and Methods This double-blind, randomized clinical trial was carried out in the Yazd Research and Clinical Center for Infertility, Yazd, Iran. We studied 145 women who were participants in an ART program. During the first phase of the study, all patients underwent induction of anesthesia with thiopental and received analgesia with remifentanil or fentanyl. The primary endpoint was pregnancy rate per transfer. The numbers of oocytes collected, fertilized and cleaved were recorded, as was the number of oocytes transferred and recovery profile. In the second phase of the study, all patients were followed for outcome of ART cycle. Results This study suggested that in women undergoing transvaginal ultrasound-guided oocyte retrieval procedures, the likelihood of a succ...
Journal of Clinical Anesthesia, 2016
Study objective: Day care surgery is an important arena for monitors of anesthetic depth where minimizing drug use is essential for rapid turnover. Underdosage, on the other hand, carries the risks of intraoperative awareness and pain. Transvaginal oocyte retrieval (TVOR), often performed under total intravenous anesthesia using propofol and fentanyl in Indian patients, is a procedure of special interest because, in addition to the above concerns, toxic effects of propofol on oocytes have been described. We have studied the role of entropy monitor, a depth of anesthesia monitor, in optomising drug titration and facilitating distinction between analgesic and hypnotic components of anesthesia. Design: Prospective randomized controlled study. Setting: Operating theater and postoperative recovery area. Patients: One hundred twenty American Society of Anesthesiologists class I and II female patients coming to the IVF centre for TVOR under total intravenous anesthesia using propofol and fentanyl. They were randomly allocated into 2 groups: Group EM (drugs titrated as per entropy values: state entropy and response entropy) and group CM (drugs titrated as per standard clinical monitoring). Intervention: None. Measurements: Total propofol consumption (TP), total fentanyl consumption (TF), on-table recovery time (T1), time to discharge (T2), intraoperative awareness (A). Main results: Patients in group EM demonstrated 6.7% lesser consumption of propofol (P= .01), 10.9% more consumption of fentanyl (P= .007) and 1 minute faster recovery on-table (P= .009) as compared to group CM. In the PACU, only 10% patients of group EM required supplemental analgesia as opposed to 28.3% in CM group (P= .01). Time to discharge was similar in both groups and no intraoperative awareness was noted.
Anesthesia for In Vitro Fertilization
Anesthesia & Analgesia, 1999
Ultrasonically guided transvaginal oocyte retrieval is relatively short procedure that is performed on an outpatient basis. The optimal anesthetic technique should allow good surgical anesthesia with minimal side effects, a short receovery time, and, if possible, a high rate of successful pregnancy. Spinal anesthesia is often used in this institution, as well as many others, for this procedure. The addition of fentanyl may be effective for both intraoperative and postoperative pain relief. We assessed the effect of adding fentanyl to 1.5% lidocaine in women undergoing ultrasonically guided oocyte retrieval. Seventy-eight women were randomized to receive 45 mg of hyperbaric 1.5% lidocaine with or without 10 g of fentanyl. Visual analog scale (VAS) pain scores were lower in the operating room (OR) (P Ͻ 0.05) and postanesthesia care unit (PACU) (P Ͻ 0.0005) for the group that received fentanyl. In addition, the amount of narcotic required in the PACU was less in the fentanyl group (P Ͻ 0.005). There was no difference in VAS scores the evening of or 24 h after the procedure. The amount of analgesics and narcotics required after discharge was the same for both groups. Timed variables, such as time to urination, ambulation, and discharge, were the same for both groups of women. The addition of fentanyl to lidocaine for transvaginal oocyte retrieval results in a more comfortable patient in the OR and PACU. Implications: This study demonstrates that when fentanyl is added to a local anesthetic, lidocaine, with spinal anesthesia for egg retrieval procedures, patients are more comfortable during the procedure compared with those who receive lidocaine alone. In addition, the narcotic requirements of patients are less in the postanesthesia care unit.
Gynecological Endocrinology, 2012
The main goal of the present retrospective study is to compare four analgesic methodologies (EMLA cream, propofol, thiopental sodium, sevoflurane) for in vitro fertilization (IVF) oocyte retrieval. We found that most anaesthetic parameters were not significantly different among all treatments. In contrast, significant differences were revealed in all groups for total number of oocytes retrieved per patient, rate of mature oocytes at metaphase II stage (MII) and percentage of fertilization and embryo development. In the EMLA cream and thiopental sodium groups we observed the highest percentage of MII oocytes (P < 0.001). Fertilization rate in the EMLA and sevoflurane groups were similar but significantly higher than the propofol and thiopental sodium groups (P < 0.001). The highest rate of anomalous fertilization was observed in the propofol group. Rate of embryo development was similar in all groups but sevoflurane group had a lower percentage of good embryos. In conclusion, by comparing different anaesthetic techniques with different mechanisms of action and administration, potential negative effects of these drugs on the initial stages of human IVF procedure were revealed. Therefore, a local anaesthetic cream is proposed as an acceptable alternative option for anaesthesia during transvaginal oocyte retrieval. Gynecol Endocrinol Downloaded from informahealthcare.com by UNIVERSITA DEGLI STUDI DI PISA on 11/08/12
Turkish Journal of Medical Sciences
Aim: To compare the eff ects of 2 diff erent anesthetic techniques used for oocyte retrieval. Comparison was made based on the number of retrieved and fertilized oocytes, metaphase 2 (M2, mature) oocytes, and transferred embryos, as well as fertilization, pregnancy, and live birth rates. Ultrasound-guided transvaginal oocyte retrieval for in vitro fertilization is one of the most common minor surgical procedures. Despite this, it is stressful and painful for the patient; most patients request sedation and/or pain relief. Propofol, which is frequently used for general anesthesia in such procedures, has been suspected to damage oocytes. Materials and methods: Results from 70 patients without premedication were compared in this randomized prospective study. Patients were divided into 2 groups based on treatment. Th ose in Group G received intravenous general anesthesia with atropine (10 μg kg-1), remifentanil (1 μg kg-1), and propofol (2.5 mg kg-1), while patients in Group P received a paracervical block with 100 mg of prilocaine (2%) and 0.75 mg kg-1 of intramuscular meperidine. Results: Our results revealed no statistically signifi cant diff erence between the 2 groups in terms of the fertilization rate. Th e numbers of retrieved and mature oocytes and transferred embryos and the pregnancy rate were greater in the general anesthesia group, although only the number of transferred embryos showed a statistically signifi cant diff erence (P = 0.045). Conclusion: According to our data, both anesthesia techniques can be used for oocyte retrieval since there were no diff erences in fertilization, pregnancy, or live birth rates between the 2 groups.
Journal of Assisted Reproduction and Genetics, 1995
Objective: Our objective was to evaluate retrospectively the influence of different types of anesthesia on the outcome of ovum retrieval. Methods: Sedation combined with local anesthesia was used on 120 occasions (Group I), epidural block in 139 ovum retrievals (Group II), and general anesthesia in 173 cycles (Group III). Results: No differences were found in embryo yield or number or
Anesthesia for in vitro fertilization: the addition of fentanyl 1.5% lidocaine
Anesthesia & Analgesia
Ultrasonically guided transvaginal oocyte retrieval is relatively short procedure that is performed on an outpatient basis. The optimal anesthetic technique should allow good surgical anesthesia with minimal side effects, a short receovery time, and, if possible, a high rate of successful pregnancy. Spinal anesthesia is often used in this institution, as well as many others, for this procedure. The addition of fentanyl may be effective for both intraoperative and postoperative pain relief. We assessed the effect of adding fentanyl to 1.5% lidocaine in women undergoing ultrasonically guided oocyte retrieval. Seventy-eight women were randomized to receive 45 mg of hyperbaric 1.5% lidocaine with or without 10 g of fentanyl. Visual analog scale (VAS) pain scores were lower in the operating room (OR) (P Ͻ 0.05) and postanesthesia care unit (PACU) (P Ͻ 0.0005) for the group that received fentanyl. In addition, the amount of narcotic required in the PACU was less in the fentanyl group (P Ͻ 0.005). There was no difference in VAS scores the evening of or 24 h after the procedure. The amount of analgesics and narcotics required after discharge was the same for both groups. Timed variables, such as time to urination, ambulation, and discharge, were the same for both groups of women. The addition of fentanyl to lidocaine for transvaginal oocyte retrieval results in a more comfortable patient in the OR and PACU. Implications: This study demonstrates that when fentanyl is added to a local anesthetic, lidocaine, with spinal anesthesia for egg retrieval procedures, patients are more comfortable during the procedure compared with those who receive lidocaine alone. In addition, the narcotic requirements of patients are less in the postanesthesia care unit.