Safety of a freestanding surgical unit for the assisted reproductive technologies.

OBJECTIVE: To determine the safety of a freestanding surgical unit for assisted reproductive technology (ART), using the rate of unplanned admissions to a hospital within 24 hours of surgery. DESIGN: Prospective. SETTING: A freestanding surgical unit within a medical office building. PATIENTS: A mixture of private and university-referred patients undergoing 6,776 ART surgical procedures. MAIN OUTCOME MEASURES: Patients admitted during the first 24 hours of surgery were recorded and hospital progress was monitored for invasive procedures, treatments, time of discharge, and residual complications. Variables tabulated included age, fertility diagnosis, ART procedure, E2 level, number of follicles by ultrasound, previous surgery, and type of anesthesia. RESULTS: There were 11 hospital admissions (0.16%). Four patients required surgery: one laparoscopy and three laparotomies. Admissions after vaginal oocyte retrieval were no different from those after GIFT via laparoscopy, 0.16% versus 0.18%, respectively. The number of admissions after monitored anesthesia care was higher than expected compared with general anesthesia. Profiles of hospitalized patients showed no apparent differences from the nonhospitalized patients. CONCLUSIONS: Surgical procedures for ART performed in a freestanding surgical unit can be performed safely with a low hospitalization rate and minimal morbidity.

Comparison of pregnancy rates following gamete intrafallopian transfer (GIFT) under general anesthesia with thiopental sodium or propofol.

STUDY OBJECTIVE: To determine whether the pregnancy rate for gamete intrafallopian transfer (GIFT) patients who received thiopental sodium was different from the pregnancy rate for patients who received propofol for the induction of general anesthesia. DESIGN: Retrospective review of clinical records. SETTING: Private outpatient infertility clinic. PATIENTS: Two hundred eighty-two consecutive GIFT procedures performed on 230 patients with infertility. INTERVENTION: Patients undergoing GIFT were divided into two groups on the basis of whether they received thiopental or propofol for induction of anesthesia. MEASUREMENTS AND MAIN RESULTS: Clinical pregnancy following each GIFT procedure was assessed by multiple-serum beta human chorionic gonadotropin and ultrasound determinations. The pregnancy rates of 24.6% and 25.8% for the thiopental and propofol groups, respectively, were not significantly different. CONCLUSIONS: The pregnancy rate following GIFT for patients given propofol for induction of general anesthesia did not differ from that for patients given thiopental.

Anesthetic induction with fentanyl and intravenous lidocaine for coronary artery surgery.

In a randomized, double-blind trial, 59 patients undergoing coronary artery surgery received fentanyl 10, 15, or 25 microg/kg infused over 5 minutes for anesthetic induction. Half of the patients received intravenous lidocaine, 1.5 mg/kg, 1 minute before laryngoscopy. Efficacy of induction as judged by loss of consciousness was evaluated, and hemodynamic values during induction, laryngoscopy, and tracheal intubation were recorded each minute for 10 minutes. Plasma fentanyl concentrations were determined after termination of the fentanyl infusion. Opioid induction with fentanyl was successful in 90% (18 of 20) of patients receiving 25 microg/kg, 89% (17 of 19) of patients receiving 15 microg/kg, but only 55% (11 of 20) of patients receiving 10 microg/kg (P < .01). While plasma fentanyl concentrations were proportional to the dose infused (25 ng/mL, 18 ng/mL, and 14 ng/mL in the 25, 15. and 10 microg/kg fentanyl groups, respectively), there was no relationship between plasma fentanyl concentration and hemodynamic response to laryngoscopy or intubation. Opioid induction caused a gradual decrease in blood pressure that was restored with intubation. Lidocaine partially blocked this restoration (systolic blood pressure 122 +/- 5 v 138 +/- 5 mmHg, lidocaine v placebo, 1 minute after laryngoscopy, P < .05). Fentanyl, 15 or 25 microg/kg, intravenously, is an effective induction agent for patients with coronary artery disease. Supplementation with intravenous lidocaine, 1.5 mg/kg, will obtund the increase in blood pressure that occurs with laryngoscopy and intubation and help prevent infrequent hypertensive responses seen with this opioid technique.