Effects Of Alfentanil And Nalbuphine Combined With Different Intravenous Anesthetics For Patients Undergoing Oocyte Retrieval In Reproductive Center

BackgroundUnder the promotion of comfortable medical treatment,the scale of outpatient surgery is expanding.Oocyte retrival in the reproductive center is one of the important outpatient surgeries,and most patients choose to implement anesthesia in this surgery.In order to comply with the concept of comfortable medical treatment,improve the satisfaction of patients,and ensure the safety of the operation,anesthesiologists should reasonably choose anesthesia drugs.Propofol and nalbuphine have been shown to be safe for patients undergoing oocyte retrival surgery,but propofol can cause injection pain and inhibit respiratory circulation,and nabuphine has a long duration of action,which is prone to excessive sedation after surgery.Alfentanil has a strong analgesic effect and short duration,with few side effects,and remimazolam is a new type of sedative with weak respiratory circulation inhibition.But there have been no reports of alfentanil and remimazolam for oocyte retrieval.ObjectiveThis study is divided into two parts.In the first part,alfentanil and nalbuphine combined with propofol was used for the surgery,comparing the analgesic efficacy and safety of the two opioid analgesics,and exploring the appropriate dose of analgesics.In the second part,the appropriate analgesic dose obtained from the results of the first part is proposed to use the appropriate analgesic dose combined with propofol or remimazolam for the surgery,comparing the sedative effect of the two intravenous anesthetic drugs,and exploring the appropriate selection and matching scheme of anesthesia drugs for egg retrieval surgery,in order to provide a reference for the clinic.PartⅠEffects of alfentanil and nalbuphine combined with propofol for patients undergoing oocyte retrieval in reproductive centerMethods1.PatientsA total of 200 patients who underwent ultrasound-guided outpatient oocyte retrieval surgery in our hospital from June 2021～December 2021 were collected.Patients eligible for enrollment were divided into four groups using random number tables:alfentanil 1group（A1）,alfentanil 2 group（A2）,nalbuphine group（N）,and control group（C）.All four groups of patients were treated with propofol 2 mg/kg for general anesthesia induction,before the start of surgery,A1 group was intravenously given alfentanil 5μg/kg,A2 group was intravenously given alfentanil 10μg/kg,N group was intravenously given nalbuphine0.1 mg/kg,group C was given the same amount of normal saline,and propofol was added as appropriate.2.Material（1）Data extracted from the medical records included height,weight,age,and ASA grade.（2）Heart rate（HR）,mean arterial pressure（MAP）,and oxygen saturation（Sp O₂）at all time points in the four groups.（3）VAS score and Ramsay score of the four groups at each time point（T₄～T₆）after surgery.（4）Number of body movements,dosage of propofol,recovery time,operative time and number of follicles.（5）Nausea and vomiting,dizziness,drowsiness,skin itching and other adverse reactions 6hours after surgery.Rusults1.200 patients were included,50 per group.There was no significant difference in the general data of the four groups（P>0.05）.2.There was no significant difference in HR and Sp O₂between the four groups at each time point（P>0.05）.No patient had a blood oxygen lower than 90%and needed to use a mask to give oxygen,although some patients had transient blood oxygen less than 95%,the blood oxygen rose rapidly after the jaw was raised.3.Compared with the other three groups,the dosage of propofol in group C increased significantly（P<0.05）,and the blood pressure decreased significantly during surgery,and the incidence of hypotension in group C increased significantly（P<0.05）.Compared with the group N and group A1,the dosage of propofol in the group A2 was significantly reduced（P<0.05）.4.Compared with group C and group N,the awakening time and body movement frequency of group A1 and A2 were significantly reduced（P<0.05）.One patient in group C suspended surgery due to obvious body movement affecting the operation.5.There was no significant difference in operation time and number of follicles between the four groups（P>0.05）.6.There was no significant difference in Ramsay score between the four groups at each time point after surgery（P>0.05）.Compared with group C,the VAS score of groups A1and A2 was significantly decreased 30 minutes and 6 hours after surgery（P<0.05）.7.There was no significant difference in the incidence of drowsiness 6 hours after surgery（P>0.05）,and compared with group C,the incidence of drowsiness at awakening in group A1 and N was significantly reduced（P<0.05）.Compared with the group N,the incidence of drowsiness in the group A1 was significantly reduced 30 minutes after surgery（P<0.05）,and the incidence of drowsiness in the group A2 was significantly increased at awakening and 5 minutes after surgery（P<0.05）.8.Compared with the other three groups,the incidence of dizziness in the group N was significantly increased at awakening,5 minutes and 6 hours after surgery（P<0.05）.9.Compared with the other three groups,the incidence of nausea and vomiting in the group N was significantly increased 5 minutes,30 minutes and 6 hours after surgery（P<0.05）.Compared with the group C,the group A1 and A2 had significantly fewer limited activities and eating difficulties（P<0.05）,and no skin itching occurred.Conclusions1.Alfentanil and nalbuphine can be used safely and effectively for patients undergoing oocyte retrieval.Both can produce good analgesic effect.2.Alfentanil can maintain the stability of breathing and circulation,and reduce the occurrence of postoperative adverse events,and the recommended dose is 5μg/kg.3.Nalbuphine has longer action time,and is more likely to cause postoperative dizziness,lethargy,nausea and vomiting.PartⅡEffects of remimazolam and propofol combined with alfentanil for patients undergoing oocyte retrieval in reproductive centerMethods1.PatientsA total of 100 patients who underwent ultrasound-guided ovectomy outpatient surgery in our hospital from November 2022～December 2022 were collected.Patients eligible for enrollment were divided into two groups using random number tables:propofol group（PA group）and remimazolam group（RA group）.In both groups,the patients were given 5μg/kg intravenously before surgery,and when anesthesia was induced,propofol 2 mg/kg was intravenously given in the PA group,and remimazolam 0.2mg/kg was given intravenously in the RA group,and intravenous anesthesia was added according to the situation.2.Materials（1）Data extracted from the medical records included height,weight,age,and ASA grade.（2）Heart rate（HR）,mean arterial pressure（MAP）,and blood oxygen saturation（Sp O₂）at each time point of both groups.（3）The number of intraoperative intravenous anesthetics required in both groups was recorded.（4）The number of follicles,operation time,awakening time（time from completion of surgery to MOAA/S score≥3）,and the MOAA/S score at the time of awakening were recorded.（5）The VAS score of each postoperative time point（T₄～T₆）were recorded.（6）The Christensen fatigue score of T₀,T₅,T₆and 24 hours after discharge were recorded.（7）The occurrence of adverse reactions such as injection pain,choking,hypotension,bradycardia,respiratory depression,and postoperative nausea and vomiting,drowsiness and dizziness were recorded.Results1.100 patients were included,50 per group.There was no significant difference in the general data of both groups（P>0.05）.2.In both groups,some patients had physical movements during surgery,and the proportion of patients without additional drugs in the propofol group was significantly higher than that in the remimazolam group（P<0.05）.3.There were no significant differences in awakening time,operation time and number of oocyte retrievals between the two groups（P>0.05）.4.There were no significant differences in MOAA/S score,postoperative VAS score and fatigue score between the two groups（P>0.05）.5.There was no significant difference in age,BMI and ASA grade between the two groups（P>0.05）.6.Neither group of patients had choking during the induction process.Thirty-nine patients in the propofol group had obvious injection pain,while no patient in the remimazolam group had injection pain（P<0.05）.7.There was no significant difference in mean arterial pressure at each time point between the two groups（P>0.05）.8.Compared with the propofol group,the heart rate of the remimazolam group from T₂to T₆was significantly increased（P<0.05）.9.There was no significant difference in intraoperative respiratory rate and blood oxygen between the two groups.No patient experienced respiratory depression,and only a few patients had a transient decrease in blood oxygen at the time of induction,and the blood oxygen of patients were all above 95%.10.There was no significant difference in postoperative nausea,vomiting,dizziness and drowsiness between the two groups（P>0.05）.Conclusions1.Remimazolam used for oocyte retrieval surgery can produce effective sedation and rapid awakening,but its sedative effect is slightly weaker than propofol.2.Remimazolam does not have injection pain,and has little effect on respiratory circulation and low rate of postoperative adverse events.3.Both remimazolam and propofol rarely cause postoperative fatigue.