Abstract
ABSTRACTObjective:To compare the anesthetic techniques using propofol and fentanyl versus midazolam and remifentanil associated with a paracervical block with lidocaine in performing ultrasound-guided transvaginal oocyte aspiration.Methods:A randomized double-blind clinical trial (#RBR-8kqqxh) performed in 61 women submitted to assisted reproductive treatment. The patients were divided into two groups: anesthetic induction with 1mcg/kg of fentanyl associated with 1.5mg/kg of propofol (FP Group, n=32), in comparison with anesthetic induction using 0.075mg/kg of midazolam associated with 0.25mcg/kg/min of remifentanil, and paracervical block with 3mL of 2% lidocaine (MRPB Group, n=29). Main outcome measures: human reproduction outcomes, modified Aldrete-Kroulik index, hemodynamic parameters, and salivary cortisol.Results:The results revealed a higher number of embryos formed in the FP Group (p50=2 versus 1; p=0.025), gestation rate two times higher in the FP Group (44.4% versus 22.2%; p=0.127), less time to reach AK=10 in the MRPB Group (p50=10 versus 2; p<0.001), and lower mean of hemodynamic parameters in the MRPB Group (p<0.05).Conclusion:Anesthesia with fentanyl and propofol as well as with midazolam, remifentanil, and paracervical block offered satisfactory anesthetic conditions when performing assisted reproduction procedures, providing comfort for the patient and physician.
Highlights
IntroductionThe use of propofol in assisted reproduction procedures has already been established, and the concentration of this medication in follicular fluid is proportional to the total quantity infused, since high doses are needed to reach effects that harm oocyte quality
Prolonged procedures with greater quantities of anesthetics could affect quality of oocytes.(3,4) The combined use of fentanyl and propofol enables decreasing the maintenance dose of the second drug, with an adequate anesthesia plan and shorter time for recovery of consciousness.(5) Remifentanil has properties appropriate for anesthesia at outpatients setting, such as rapid onset, short half-life even with continuous infusion, and potent analgesia, and can be used alone or as an adjuvant drug.(6,7) Remifentanil associated with paracervical block allows satisfactory analgesia and sedation for follicular puncture.(8) Various techniques have been described in literature for promoting a safer and more comfortable ovarian puncture, from local block to general anesthesia
The first group of 32 patients was submitted to anesthetic induction with 1mcg/kg of fentanyl associated with 1.5mg/kg of propofol (FP Group); for maintenance, fractioned bolus of 20mg of propofol was used as required for each patient, taking into consideration the experience of the anesthesiologist
Summary
The use of propofol in assisted reproduction procedures has already been established, and the concentration of this medication in follicular fluid is proportional to the total quantity infused, since high doses are needed to reach effects that harm oocyte quality. Prolonged procedures with greater quantities of anesthetics could affect quality of oocytes.(3,4) The combined use of fentanyl and propofol enables decreasing the maintenance dose of the second drug, with an adequate anesthesia plan and shorter time for recovery of consciousness.(5) Remifentanil has properties appropriate for anesthesia at outpatients setting, such as rapid onset, short half-life even with continuous infusion, and potent analgesia, and can be used alone or as an adjuvant drug.(6,7) Remifentanil associated with paracervical block allows satisfactory analgesia and sedation for follicular puncture.(8) Various techniques have been described in literature for promoting a safer and more comfortable ovarian puncture, from local block to general anesthesia. There is no literature confirming the superiority of one technique over the others
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