Remifentanil with or without Propofol as Anesthesia Agents for Trans- Vaginal Ultrasonography Oocyte Retrieval (TUGOR) on Pregnancy and Anesthesia Outcomes: A Randomized Controlled Trial.

BACKGROUND: Transvaginal Ultrasound-Guided Oocyte Retrieval (TUGOR) is a painful procedure, which often requires the application of anesthesia agents. There is a controversy in the literature about the effects of administrated anesthetics for TUGOR on patients & pregnancy outcomes. OBJECTIVE: The current study aimed to compare the effects of remifentanil with or without propofol, administrated for TUGOR, on pregnancy and anesthesia outcomes. METHOD: In a double-blind randomized controlled trial, 180 candidates of TUGOR, aged 18-40 years old, were included in the study. All study women received midazolam 0.03 mg/kg and remifentanil 1 ug/kg as anesthesia induction; Later on, they were randomly assigned in two equalsize groups in terms of anesthesia maintenance, as the intervention group received remifentanil infusion 0.25 µg/kg/min and the control group received remifentanil infusion 1ug/kg/min with propofol 50-150 ug/kg/min. Hemodynamic symptoms, operation outcomes, including the side effects, and pregnancy outcomes, were compared between the study groups. The study is registered with the Iranian Clinical Trials Registry, number IRCT201611177013N15. RESULTS: Although the hemodynamic symptoms showed significantly better ranges in the remifentanil group, however, the study groups were not significantly different in durations of operation, anesthesia, and recovery. However, the anesthesia side effects during and after the operation were not significantly different between the groups; they were more common in control one. The reproductive outcomes (numbers of collected oocytes, fertilized oocytes and transferred embryos, pregnancy rates) showed better but non-significant ranges in the remifentanil group. CONCLUSION: Using remifentanil alone in comparison to remifentanil & propofol in the TUGOR procedure can be achieved better pregnancy outcomes without imposing the side effects of propofol; therefore, it is not recommended to use propofol as an anesthesia agent for a TUGOR procedure.

Effect of Glucose Containing Crystalloid Infusion on Maternal Hemodynamic Status After Spinal Anesthesia for Cesarean Section.

BACKGROUND: Despite preventive strategies, hypotension is the most common complication of spinal anesthesia in cesarean section. OBJECTIVES: The aim of this study was to assess the effect of glucose-containing crystalloid infusion on maternal hemodynamic status after spinal anesthesia for cesarean section. METHODS: In this prospective, randomized, double-blind clinical trial, 80 parturients undergoing elective cesarean section with spinal anesthesia were studied. In group A (n = 40) ringer with 1% glucose solution (10 gr glucose in 1000 mL ringer) and in group B (n = 40) only ringer solution infused before and after spinal anesthesia. Demographic data, hemodynamic change, complications and their treatments, maternal blood sugar level and neonatal APGAR (appearance, pulse, grimace, activity and respiration) score, intraoperative fluid, duration of surgery, and anesthesia were recorded in the two groups. RESULTS: The incidence of hypotension in group A was significantly lower than group B (27.5% vs 75%) (P = 0.002). Other complications (sustained hypotension, nausea, pallor, and shivering were significantly lower in parturients of the group A (P < 0.05). Maternal blood sugar (BS), before and after surgery, was not significantly different in the two groups (P = 0.207 and P = 0.239, respectively). There was no statistically significant difference in the APGAR score of neonates at the 1st and 5th minutes of the birth between the two groups (P = 0.076). CONCLUSIONS: It seems that adding 1% glucose to crystalloid solution improves the hemodynamic status and decreases post-spinal anesthesia complications without significant changes in the maternal blood sugar level and APGAR score of neonates.

Effects of the addition of low-dose ketamine to propofol-fentanyl anaesthesia during diagnostic gynaecological laparoscopy.

OBJECTIVES: Diagnostic gynaecological laparoscopy (DGL) is a brief procedure, generally performed on an outpatient basis. Propofol-fentanyl is often used for anaesthesia in minor outpatient procedures because of its rapid onset, short duration of action and smooth patient awakening. However, propofol has various cardiovascular effects such as reduced arterial pressure, cardiac output and cardiac index. Ketamine is an intravenous anaesthetic and short-acting analgesic that could alleviate the haemodynamic effects of propofol due to its sympathomimetic activity. The aim of this placebo-controlled trial was to evaluate the effects of the addition of low-dose ketamine to propofol-fentanyl anaesthesia in DGL. STUDY DESIGN: In this double-blind randomized trial, 60 healthy women undergoing gynaecological laparoscopy to investigate infertility were studied. Following injection of midazolam and fentanyl in all patients, the study group (n=30) received ketamine 0.5 mg/kg and propofol 1-2.5 mg/kg, and the placebo group (n=30) received saline 0.9% and propofol 1-2.5 mg/kg. Propofol was subsequently infused for the maintenance of anaesthesia. RESULTS: Patients in the study group had a significantly lower incidence of pain than patients in the placebo group during propofol injection (13% vs 87%, respectively; p<0.0001). After induction of anaesthesia, 16 (53%) patients in the placebo group and three (10%) patients in the study group had a decreased heart rate (p<0.001). The decrease in mean arterial pressure was greater in the placebo group compared with the study group (37% vs 7%, respectively; p<0.001). During the procedure, the total mean±standard deviation dose of propofol was 420±65 mg in the placebo group and 330±35 mg in the study group (p<0.001). Pain scores for the first 3h after the operation were significantly lower in the study group (p<0.001). CONCLUSION: Use of low-dose ketamine with propofol-fentanyl anaesthesia in patients undergoing DGL was associated with less pain during propofol injection, lower incidence of haemodynamic changes, lower total dose of propofol and improved postoperative analgesia.