Comparison of Two Different Sedation Protocols during Transvaginal Oocyte Retrieval: Effects on Propofol Consumption and IVF Outcome: A Prospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Population/Eligibly Criteria
2.2. Groups, Anesthesia Management and Assessments
2.3. IVF Protocol
2.4. Outcome Measures
- (1)
- Anesthesiological parameters: total dose of dexmedetomidine or remifentanil administered, hemodynamic parameters, dose of ephedrine, dose of atropine, BIS values, OAA/S score, adverse effects during anesthesia, time required to achieve the maximum OAA/S score, PONV, VAS, time required to achieve PADSS score ≥9 and the overall patients’ and gynecologist’ satisfaction.
- (2)
- IVF outcomes (definitions used were as reported in Zegers-Hochschild et al., 2017 [24]): number of oocytes retrieved at the day of the OR, number of fertilized embryos [number of oocytes with two nuclei (2PN) divided by the total number of oocytes retrieved], embryo quality and number of top quality embryos at day 3 (Veeck: 5-point scale: Grade 1 = excellent, Grade 2 = good, 3 = moderate, 4 = poor, 5 = unsustainable), cycle cancelation (in cases with premature ovulation, no oocytes retrieved or no embryos available for transfer), biochemical (defined as a positive pregnancy test), ectopic, clinical pregnancy (defined as the presence of fetal heart beat at 7 weeks gestation) and miscarriage rates (defined as pregnancy loss up to the 20th week of pregnancy per positive pregnancy test). Embryo quality was assessed according to morphological criteria based on the overall blastomere number, size, appearance and degree of fragmentation [25].
2.5. Sample Size
2.6. Statistical Analysis
3. Results
3.1. Study Characteristics
3.2. Primary Outcomes
3.3. Secondary Outcomes
4. Discussion
Limitations and Strengths
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Observer’s Assessment of Alertness/Sedation Scale (OAA/S) | ||
---|---|---|
Responds readily to name spoken in normal tone | 5 | |
Lethargic response to name spoken in normal tone | 4 | |
Responds only after name is called loudly and/or repeatedly | 3 | |
Responds only after mild prodding or shaking | 2 | |
Does not respond to mild prodding or shaking | 1 | |
Visual Analogue Scale (VAS) | ||
0____________________________________10 | ||
No pain | The worst pain | |
Postoperative nausea/vomiting (PONV) assessment | ||
VitalSigns | 2 = within 20% of preoperative value 1 = 20–40% of preoperative value 0 ≥ 40% preoperative value | |
Activity and mental status | 2 = Oriented × 3 AND has a steady gait 1 = Oriented × 3 OR has a steady gait 0 = Neither | |
Nausea and/or vomiting | 2 = Minimal 1 = Moderate, having required treatment 0 = Severe, requiring treatment | |
Pain | 2 = Minimal 1 = Moderate, having required treatment 0 = Severe, requiring treatment | |
Surgicalbleeding | 2 = Minimal 1 = Moderate 0 = Severe | |
none | 0 | |
Nausea | 1 | |
<2 episodes of vomiting | 2 | |
>2 episodes of vomiting | 3 | |
Patients’ and gynecologist’s overall satisfaction assessment | ||
Assessment is performed using the following two questions: 1st question: Are you satisfied with the anesthetic technique used? (Yes/No) 2nd question: Would you like to use the same anesthetic technique in the future again? (Yes/No) |
Group DEX (n = 36) | Group REMI (n = 36) | p-Value | |
---|---|---|---|
Age (years) | 38.5 (8.0) | 37.5 (5.0) | 0.709 |
BMI (kg/m2) | 24.3 ± 4.9 | 24.3 ± 4.1 | 0.986 |
Smoking, n (%) | 9 (25%) | 15 (41.6%) | 0.211 |
Alcohol (>4 cups/wk), n (%) | 5 (13.9%) | 4 (11.1%) | 0.721 |
Age of menarche (years) | 12.58 ± 1.27 | 12.83 ±1.13 | 0.382 |
AFC | 8.13 ± 2.21 | 8.1 ± 2.64 | 0.962 |
AMH (ng/mL) | 2.19 ± 0.8 | 2.16 ± 0.7 | 0.867 |
Basal FSH (IU/L) | 8.4 ± 1.7 | 8.1 ± 1.5 | 0.410 |
Basal PRL (ng/mL) | 9.83 ± 3.3 | 9.1 ±2.58 | 0.299 |
ASA class, n | |||
1 | 19 (52.7%) | 16 (44.4%) | 0.638 |
2 | 17 (47.2%) | 20 (55.5%) | |
Infertility, n | |||
Primary | 27 (75%) | 31 (86%) | 0.372 |
Secondary | 9 (25%) | 5 (13.8%) | |
Cause of infertility, n (%) | |||
Unexplained | 17 (47%) | 19 (52%) | 0.637 |
Male | 7 (19.4%) | 6 (16.7%) | 0.759 |
Ovulatory | 9 (25%) | 6 (16.7%) | 0.384 |
Tubal | 3 (8.3%) | 5 (13.9%) | 0.453 |
Duration of infertility (years) | 2.12 ±0.64 | 2.25 ± 0.72 | 0.409 |
Protocol, n | |||
Long | 10 (27.7%) | 12 (33.3%) | 0.798 |
Short | 26 (72.2%) | 24 (66.7%) | |
MALE partner | |||
BMI (kg/m2) | 25.2 ± 3.6 | 24.9 ± 3.5 | 0.720 |
Smoking (current), n (%) | 14 (38.9%) | 17 (47.2%) | 0.475 |
Alcohol (>4 cups/wk), n (%) | 9 (25%) | 8 (22.2%) | 0.781 |
Varicocele/Cryptorchidism/Obstructions in reproductive tract, n (%) | 4 (11/1%) | 3 (8.3%) | 0.69 |
Previous surgery/Infectious parotitis, n (%) | 3 (8.3%) | 3 (8.3%) | 1 |
(a) | |||
Group DEX (n = 36) | Group REMI (n = 36) | p-Value | |
Intraoperative data | |||
Anesthesia duration (min) | 22.0 (7.8) | 22.0 (7.5) | 0.599 |
Surgery duration (min) | 11.5 (7.5) | 10.0 (7.8) | 0.739 |
Cumulative Propofol consumption (mg) | 81.6 ± 64 | 17.2 ± 36.4 | <0.001 |
Dexmedetomidine (μg) | 27.7 ± 9 | - | - |
Remifentanil (μg) | - | 270 ± 78.5 | - |
Airway obstruction, n | 1 (2.7%) | 5 (13.9%) | 0.199 |
Need for assisted ventilation, n | 14 (38.9%) | 8 (22.2%) | 0.200 |
Rigidity, n | 0 | 0 | - |
Hypotension, n | 2 (5.5%) | 0 | 0.493 |
Bradycardia, n | 1 (2.7%) | 0 | 1.0 |
Postoperative data | |||
OAA/S time to 5 (min) | 1.18 ± 1.46 | 1 ± 1.76 | 0.706 |
Patient satisfaction | |||
1st question (Yes/No) | 31/5 | 36/0 | 0.054 |
2nd question (Yes/No) | 35/1 | 36/0 | 1.0 |
Physician satisfaction | |||
1st question (Yes/No) | 32/4 | 36/0 | 0.120 |
2nd question (Yes/No) | 35/1 | 36/0 | 1.0 |
VAS, 0–10 point | 0.27 ± 0.7 | 0.4 ± 1.15 | 0.552 |
PONV, n | |||
Nausea | 0 | 2 (5.5%) | 0.2 |
Vomitus <2 episodes | 0 | 1 (2.7%) | |
Hypotension, n | 0 | 0 | - |
Bradycardia, n | 0 | 0 | - |
Post Anesthesia Discharge Score (min) | 15.0 (13.5) | 5.0 (10.0) | 0.028 |
(b) | |||
Group DEX (n = 36) | Group REMI (n = 36) | p-Value | |
Number of oocytes retrieved | 5 ± 2.3 | 5.5 ±3.2 | 0.462 |
Embryo quality, n | |||
1 | 28 | 18 | 0.040 |
2 | 8 | 17 | |
2PN/total number of oocytes | 0.6 | 0.6 | 0.469 |
Top quality Day 3 | 20.7 (5.4) | 23.4 (4.7) | 0.052 |
Positive HCG test, n | 7 (19.4%) | 10 (27.7%) | 0.580 |
Clinical pregnancy, n | 7 (19.4%) | 10 (27.7%) | |
Miscarriage, n | 3 (8.3%) | 0 | 0.051 |
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Matsota, P.; Sidiropoulou, T.; Vrantza, T.; Boutsikou, M.; Midvighi, E.; Siristatidis, C. Comparison of Two Different Sedation Protocols during Transvaginal Oocyte Retrieval: Effects on Propofol Consumption and IVF Outcome: A Prospective Cohort Study. J. Clin. Med. 2021, 10, 963. https://doi.org/10.3390/jcm10050963
Matsota P, Sidiropoulou T, Vrantza T, Boutsikou M, Midvighi E, Siristatidis C. Comparison of Two Different Sedation Protocols during Transvaginal Oocyte Retrieval: Effects on Propofol Consumption and IVF Outcome: A Prospective Cohort Study. Journal of Clinical Medicine. 2021; 10(5):963. https://doi.org/10.3390/jcm10050963
Chicago/Turabian StyleMatsota, Paraskevi, Tatiana Sidiropoulou, Tereza Vrantza, Maria Boutsikou, Elena Midvighi, and Charalampos Siristatidis. 2021. "Comparison of Two Different Sedation Protocols during Transvaginal Oocyte Retrieval: Effects on Propofol Consumption and IVF Outcome: A Prospective Cohort Study" Journal of Clinical Medicine 10, no. 5: 963. https://doi.org/10.3390/jcm10050963
APA StyleMatsota, P., Sidiropoulou, T., Vrantza, T., Boutsikou, M., Midvighi, E., & Siristatidis, C. (2021). Comparison of Two Different Sedation Protocols during Transvaginal Oocyte Retrieval: Effects on Propofol Consumption and IVF Outcome: A Prospective Cohort Study. Journal of Clinical Medicine, 10(5), 963. https://doi.org/10.3390/jcm10050963