Anaesthesia for ultrasound guided oocyte retrieval: midazolam/remifentanil versus propofol/fentanyl regimens

Abstract

quired manual ventilation more frequently through a facemask than those patients treated with the mi-To evaluate the quality of intra-operative anaesthesia dazolam/remifentanil combination (50% and 30%, reand recovery characteristics of two different anspectively; P < 0.05). The time to achieve an Aldrete's aesthesia regimens, 60 healthy women undergoing score of 10 was shorter in the midazolam/remifentanil ultrasound guided oocyte retrieval for in vitro ferpatients (2±2 min) than in those who received protilization procedures were randomly allocated to repofol/fentanyl (4±2 min) (P < 0.001), but no differences ceive either a propofol/fentanyl or a midazolam/ were observed in the time required to be 'fit to disremifentanil based anaesthesia. The surgical procharge' from the post-anaesthesia care unit. We concedure was successful in all patients and no severe clude that the use of a midazolam/remifentanil side effects were reported by any patient. Four patients regimen is as effective and safe as a fentanyl/propofol in the midazolam/remifentanil group (13%) would not regimen in patients undergoing transvaginal oocyte accept the same anaesthetic procedure for further retrieval for in vitro fertilization procedures. in vitro fertilization treatment due to intra-operative awareness, while all propofol/fentanyl patients were Keywords: ambulatory anaesthesia; anaesthetic, intravenous, propofol, midazolam; opioids, remi-prepared to accept the same procedure again (P < 0.05). Patients in the propofol/fentanyl group re-fentanil, fentanyl; in vitro fertilization.

Anaesthetic Issues in In-vitro Fertilisation

“…Therefore, this agent cannot be recommended despite the lack of data indicating that it reduces the success rate of fertility treatment [5]. Halogenated agents have been associated with reduced reproductive success in clinical practice and must therefore be used with caution [6,7]. Opioids, and especially fentanyl and remifentanil, do not seem to affect reproductive success [7].…”

“…Halogenated agents have been associated with reduced reproductive success in clinical practice and must therefore be used with caution [6,7]. Opioids, and especially fentanyl and remifentanil, do not seem to affect reproductive success [7]. In addition, midazolam and ketamine seem to be acceptable drugs for use during assisted reproduction [8,9].…”

Pharmacokinetics, safety, and tolerability of Pentoxifylline intravaginal gel for subfertile/ infertile couples with low sperm quality: phase I randomized controlled clinical trial in healthy women

“…All of the women given propofol and fentanyl were satisfied and said they would accept conscious sedation again. 884 [Evidence level 1b]…”

Anesthesia for Assisted Reproductive Technologies

“…22 When used in small bolus or infusion doses for anxiolysis and sedation for ART in humans, midazolam has not been found in follicular fluid and does not seem to cause teratogenicity. 23,24 Ketamine in a dose of 0.75 mg/kg, administered with midazolam 0.06 mg/kg, has been noted to be an acceptable alternative to general anesthesia with isoflurane. Although the study had inadequate power, no differences in reproductive outcomes were observed.…”

“…Using this option, most patients can be managed with spontaneous ventilation via a simple oxygen mask and the use of carbon dioxide analysis. 24 Anesthetics managed in this fashion have higher patient acceptance than conscious sedation, due to improved pain relief and less awareness during the surgical procedure. 24 Alternatively, general anesthesia with intubation and maintenance with volatile halogenated agents has been used successfully; however, higher rates of nausea and emesis and more unplanned admissions have been observed when compared with a propofol, alfentanil, and an air/oxygen mixture.…”