Open Access Open Access  Restricted Access Subscription or Fee Access

Remifentanil versus remifentanil with paracervical block on plasma remifentanil concentrations and pulmonary function tests for transvaginal ultrasound-guided oocyte retrieval

Berrin Gunaydin, MD, PhD, I. Kivilcim Ozulgen, MD, Ertan Ozturk, MD, Zeki T. Tekgul, MD, Kadir Kaya, MD

Abstract


Study objective: The aim of this study is to compare plasma remifentanil concentrations and pulmonary function tests in subjects receiving remifentanil infusion (RI) versus RI with paracervical block (PCB) during transvaginal ultrasound-guided oocyte retrieval (TUGOR).
Design: Prospective, randomized.
Setting: Assisted Conception Unit.
Patients: Forty American Society of Anesthesiologists I subjects requiring TUGOR.
Intervention: After ovarian hyperstimulation, subjects were randomly allocated into two groups to receive either RI (Group RI, n = 20) or RI with PCB (Group RI + PCB, n = 20).
Measurements: Heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), end tidal carbon dioxide (ETCO2) tension, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and amount of remifentanil used were collected. Plasma remifentanil concentrations were calculated with STANPUMP software.
Main results: HR, MAP, ETCO2, SpO2, FEV1, and FVC did not differ between the groups. Total amount of remifentanil used were 486 ± 1.81 μg and 321 ± 0.87 μg in groups RI and RI + PCB, respectively, (p < 0.05). In Group RI, plasma remifentanil concentrations were 4.7 ng mL−1 and 4.2 ng mL−1 during the second transvaginal puncture, and at the end of TUGOR, respectively, whereas corresponding plasma remifentanil concentrations were 3.1 ng mL−1 and 2.6 ng mL−1in Group RI + PCB (p < 0.05).
Conclusion: Both anesthesia regimens provided satisfactory analgesia without affecting FEV1 and FVC, but significantly higher plasma remifentanil concentrations were calculated when only RI was used as an anesthetic technique.

Keywords


plasma remifentanil concentration, pulmonary function tests, in vitro fertilization (IVF), oocyte retrieval

Full Text:

PDF

References


Boyers SP, Lavy G, Russell JB, et al.: A paired analysis of in vitro fertilization and cleavage rates of first versus last recovered preovulatory human oocytes exposed to varying interval of 100% CO pneumoperitoeum and general anesthesia. Fertil Steril. 1987; 48: 969-974.

Ditkoff EC, Plump J, Selick A, et al.: Anesthesia practices in the United States common to in vitro fertilization (IVF) centers. J Assist Reprod Genet. 1997; 11: 115-117.

Trout SW, Vallrand AH, Kemmann E: Concious sedation for in vitro fertilization. Fertil Steril. 1998; 69: 799-808.

Van Den Eynde N: Anaesthesia for in vitro fertilization. Acta Anaesthesiol Belg. 2002; 53: 339-341.

Tsen LC, Schultz R, Martin R, et al.: Intrathecal low dose bupivacaine versus lidocaine for in vitro fertilization procedures. Reg Anesth Pain Med. 2001; 26: 52-56.

Wilhelm W, Hammedeh ME, White PH, et al.: General anesthesia versus monitored anesthesia care with remifentanil for assisted reproductive technologies: Effect on pregnancy rate. J Clin Anesth. 2002; 14: 1-5.

Bouillon T, Bruhn J, Radu-Radulescu L, et al.: A model of the ventilatory depressant potency of remifentanil in the non-steady state. Anesthesiology. 2003; 99: 779-787.

Kaya K, Ozturk E, Tuncer B, et al.: Remifentanil infusion and paracervical block combination for transvaginal ultrasound guided oocyte retrieval. Turk J Med Sci. 2005; 35: 99-105.

Ozturk E, Gunaydin B, Karabacak O, et al.: Remifentanil infusion and paracervical block combination versus remifentanil alone during in vitro fertilisation (IVF). Turk J Med Sci. 2006; 36: 105-111.

Wilhelm W, Biedler A, Hammadeh ME, et al.: Remifentanil for oocyte retrieval: A new single-agent monitored anaesthesia care technique. Anaesthesist. 1999; 48: 698-704.

Shafer SL: STANPUMP: A Program for Computer Controlled Drug Administration and Pharmacokinetic Simulation. Stanford, CA: Stanford University School of Medicine.

Babenco HD, Conard PF, Gross JB: The pharmacodynamic effect of a remifentanil bolus on ventilatory control. Anesthesiology. 2000; 92: 393-398.

Casati A, Valentini G, Zangrillo A, et al.: Anaesthesia for ultrasound guided oocyte retrieval: Midazolam/remifentanil versus propofol/fentanyl regimens. Eur J Anaesthesiol. 1999; 263: 56-59.

Gold MI, Watkins WD, Sung YF, et al.: Remifentanil versus remifentanil/midazolam for ambulatory surgery during monitored anesthesia care. Anesthesiology. 1997; 87: 51-57.

Nieuwenhuijs DJF, Olofsen E, Romberg RR, et al.: Response surface modeling of remifentanil-propofol interaction on cardiorespiratory control and bispectral index. Anesthesiology. 2003; 98: 312-322.

Noseir RK, Ficke DJ, Kundu A, et al.: Sympathetic and vascular consequences from remifenatnil in humans. Anesth Analg. 2003; 96: 1645-1650.

Kinnard TL, Kinnard WV: Pulmonary function testing and interpretation. In Duke J (ed.): Anesthesia Secrets. 2nd edition. Philadelphia: Hanley & Belfus Inc, 2000: 429-433.




DOI: https://doi.org/10.5055/jom.2007.0014

Refbacks

  • There are currently no refbacks.