Clinical Study Of Different Doses Of Remifentanil Combined With Propofol For Painless Oocyte Retrieval

IntroductionAssisted reproductive technologies(ART)refers to the general term for treatment methods or processes related to human gametes or embryos performed in vitro for the purpose of establishing pregnancy,including artificial insemination(AI),in vitro fertilization-embryo transfer(IVF-ET)and other derivative technologies.Transvaginal oocyte retrieval under ultrasound guidance is one of its key steps.Most patients experience more than moderate pain during oocyte retrieval.The duration of oocyte retrieval is usually short which is completed in an outpatient clinic.It requires rapid onset of anesthesia and complete recovery,which is no ideal way of anesthesia.At present,the effects of anesthetics such as propofol and remifentanil on reproductive outcomes are also unclear.Objective(1)To evaluate the anesthesia effect of different doses of remifentanil combined with propofol for ultrasound-guided transvaginal oocyte retrieval(hereinafter referred to as oocyte retrieval).(2)To evaluate the effect of remifentanil combined with propofol on the outcome of assisted reproductive technologies(ART).MethodsExperiment 1.Evaluation of the anesthetic effect of different doses of remifentanil combined with propofol for painless oocyte retrieval.A total of 160 patients who underwent oocyte retrieval due to tubal infertility were selected and divided into 4 groups(n=40)by block randomization.Propofol group(P group):intraoperative only propofol was given to maintain anesthesia;remifentanil low-dose group(R1 group):anesthesia induction intravenous injection of remifentanil 0.2μg/kg combined with Propofol;remifentanil mid-dose group(group R2):anesthesia induction is induced by intravenous injection of remifentanil 0.25μg/kg combined with propofol;remifentanil high-dose group(R3 group):Anesthesia induced by intravenous injection of remifentanil 0.3μg/kg combined with propofol to maintain anesthesia.The main indicators of anesthesia quality evaluation are the number of body movements,the degree of body movements,the number of assisted breathing cases,the number of manual breathing cases,the number of eye-open patients after the operation,and the Observer’s assessment of alertness/sedation scale(OAA/S).We also evaluate OAA/S when the eyes are opened,the duration of entering the recovery room to fully awake,postoperative lower abdominal pain score and the occurrence of adverse reactions such as nausea and vomiting.Experiment 2.The effect of remifentanil combined with propofol intravenous anesthesia on the outcome of ART.In order to evaluate the effect of remifentanil combined with propofol on the outcome of ART,the cases were randomly divided into 3 groups(n=95)on the basis of Experiment 1.Blank control group(Con group),propofol group(P group)and remifentanil combined with propofol group(R+P group).P group was given simple propofol anesthesia.R+P was given the best dose of remifentanil combined with propofol.ART outcome evaluation indicators are the number of oocyte obtained,the number of MII oocyte,the rate of obtaining oocyte,the rate of MII oocyte,the rate of normal fertilization,the rate of cleavage,the rate of good embryos,the rate of implantation,the rate of clinical pregnancy and the rate of early abortion.ResultsExperiment 1:To evaluate the anesthesia effect of different doses of remifentanil combined with propofol for painless oocyte retrieval.1.Intraoperative propofol dosage of R2 and R3 group was significantly lower than that of P group and R1 group(P<0.05),and the difference between R2 and R3 group was not statistically significant(P>0.05).2.Evaluation of adverse reactions in patients during operation.There was no significant difference in intraoperative coughing among the 4 groups(P>0.05).As for the number of body movements,the number of cases with less than 2 body movements,the number of cases of grade 3 body movements,R2 and R3 groups were significantly less than P and R1 groups(P<0.05),and the difference between R2 and R3 group was not statistically significant(P>0.05).R2 group,P group,and R1 group were not statistically different(P>0.05)in the number of assisted breathing cases(including the number of hand-controlled breathing cases),while the R3 group was significantly more than the P,R1 and R2 group(P<0.05).3.The evaluation indexes of patients’ recovery quality after operation.The proportion of open eyes after operation,OAA/S value after operation and open eyes in R2 and 3 groups were significantly higher than those in P and R1 groups(P<0.05),and there was no difference between R2 and R3 groups(P>0.05).The time from entering the recovery room to fully awake in the R2 and R3 groups was significantly shorter than those in the P and R1 groups(P<0.05),and there was no significant difference between the R2 and R3 groups(P>0.05).4.Evaluation of postoperative adverse reactions.The incidence of postoperative lower abdominal pain,nausea and vomiting were not statistically significant between the 4 groups(P>0.05).Experiment 2.The effect of remifentanil combined with propofol intravenous anesthesia on the outcome of ART.1.There was no significant difference among the groups in the number of oocyte obtained in each group,the number of MII oocyte,the rate of obtaining oocyte,the rate of MII oocyte,the normal fertilization rate,the multiple PN fertilization rate,the cleavage rate,the excellent embryo rate,the D3 unavailable embryo cycle rate,the rate of sperm-egg binding disorder to ICSI(P>0.05).2.Implantation rate,clinical pregnancy rate and early abortion rate were not statistically different among the three groups(P>0.05).Conclusion1.Remifentanil combined with propofol can improve the anesthesia effect of painless oocyte retrieval and the best dosage is 0.25μg/kg.2.Remifentanil combined with propofol anesthesia has no effect on assisted reproduction outcomes(oocyte acquisition rate,MII oocyte rate,normal fertilization rate,cleavage rate,excellent embryo rate,implantation rate,clinical pregnancy rate,early abortion rate,etc.).