A prospective randomized trial comparing dexmedetomidine and midazolam for conscious sedation during oocyte retrieval in an in vitro fertilization program

Abstract

Background:Various sedative and analgesic techniques have been used for pain relief during oocyte retrieval which is the most painful part of in vitro fertilization (IVF) procedures.Aim:This study aimed at comparing dexmedetomidine and midazolam for conscious sedation in women undergoing transvaginal oocyte retrieval during an IVF program.Settings and Design:Prospective randomized double-blinded comparative study.Patients and Methods:Fifty-two patients undergoing oocyte retrieval in their first IVF cycle were randomly allocated into two equal groups. The intervention started with giving fentanyl1 mcg/kg intravenous (IV) followed by paracervical block in both groups. Then, subjects in group (D) received dexmedetomidine at a loading dose of 1 μg/kg IV over 10 min followed by 0.5 μg/kg/h infusion until Ramsay Sedation Scale (RSS) reached 3–4. Patients in group (M) received a loading dose of midazolam 0.06 mg/kg IV over 10 min followed by 0.5 mg incremental doses until RSS reached 3–4.Statistical Analysis:Statistical analysis was performed using SPSS program version 19 and EP 16 program.Results:Visual analog scale scores significantly decreased in group D than group M at 5 and 10 min during the procedure (P = 0.03 and 0.01, respectively), and at 20 min during postanesthesia care unit (PACU) time (P = 0.04). Intraoperative rescue sedation by propofol and postoperative rescue analgesia by acetaminophen showed a highly significant decrease (P < 0.01) in group D compared with group M. Furthermore, the time of PACU stay was significantly less (P < 0.01) in group D (49.03 ± 12.8 min) compared to group M (62.5 ± 18.34 min). Although significant bradycardia was noted in group D (23% of patients) during the procedure (P = 0.02), no cases were reported in group M. Patient satisfaction was significantly higher in group D (P < 0.1).Conclusion:Dexmedetomidine is an effective analgesic alternative to midazolam during oocyte retrieval for IVF. It offered not only a shorter PACU stay without significant side effects, but also better overall patient satisfaction scores.

Comparison of Two Different Sedation Protocols during Transvaginal Oocyte Retrieval: Effects on Propofol Consumption and IVF Outcome: A Prospective Cohort Study

“…To the best of our knowledge, there is only one similar study investigating the use of DEX in the clinical setting of OR, which contradicts our findings, due to its different methodology and doses of the drugs administered [10]: authors compared DEX and midazolam in women undergoing OR under conscious sedation combined with paracervical block (PCB) and found that DEX, compared to midazolam, was associated with decreased demand for rescue propofol administration. It is worth noting that the study revealed the superiority of the sedative effect of DEX vs. midazolam, as the procedural pain was adequately controlled with the PCB [10]. In our study, it seems that remifentanil administration achieved better procedural pain control, resulting in significantly less propofol consumption.…”

“…Direct comparisons with the literature is rather difficult, as there was only one study on the use of DEX during OR [10], which ended up with similar results to ours, concerning the number of oocytes obtained, embryos transferred and percentage of pregnancies per embryo transferred. Conclusively, our results showed that the use of DEX may overwhelm the potential negative effect of the higher use of propofol, as fertilization rates (preset as a primary outcome) were not affected, along with clinical pregnancy and miscarriage.…”

“…Dexmedetomidine (DEX) is a highly selective α2 adrenergic receptor agonist also used to provide CS in both surgical and non-surgical interventions, due to its sedative and analgesic properties [ 7 , 8 , 9 ]. There is strong evidence that its use, when compared to midazolam combined with paracervical block in OR, provides better post-procedural analgesia and higher overall patient satisfaction [ 10 ]. Its main advantage is the lack of respiratory depression.…”

The effect of Propofol versus Dexmedetomidine as anesthetic agents for oocyte pick-up on in vitro fertilization (IVF) outcomes

“…Elnabtity et al concluded that dexmedetomidine, used as a part of conscious sedation for oocyte retrieval, offered a favorable analgesic technique during and after the procedure with significantly less requirements than removing propofol intraoperatively 22 . It was observed that dexmedetomidine protects the ovarian tissue of the rat from ischemia and reperfusion (I/R) injury.…”

Investigation of Apoptotic Effect of Propofol, Dexmedetomidine and Medetomidine on Oocyte Cumulus Granulosa Cells in Rats

“…Anahtar sözcükler: Apoptozis, kümülüs hücreleri, deksmedetomidin, medetomidin, propofol, oosit toplama Propofol is an intravenous anesthetic drug commonly used during TUGOR because of its favorable pharmacokinetic properties and safety profile (3). Another drug used for TUGOR is dexmedetomidine, a highly selective α-2 adrenoreceptor agonist with dose-dependent sedative, hypnotic, analgesic, and sympathetic-blocking properties, and without any significant respiration-inhibiting effects (4,5). On the other hand, medetomidine, another α-2 adrenoreceptor agonist, is used in veterinary medicine for its analgesic and sedative properties (6).…”