Hemodynamic parameters and reproductive outcome after intracytoplasmic sperm injection and fresh embryo transfer in patients undergoing oocyte retrieval with general anesthesia using fentanyl, remifentanil or alfentanil – A randomized clinical trial

Farnoush Farzi, Marzieh Mehrafza, Ali Mirmansouria*, Ziba Zahiri Sorouria, Zahra Atrkar Roushana, Azadeh Raoufi, Reyhane Shalkohi, Sajedeh Samadnia, Ahmad Hossein

Objective:Anesthesia for assisted reproductive technology is very important to provide less stressful andpainful environment for patients, with minimal side effects on oocytes. In the present study, we aimed toevaluate hemodynamic parameters, recovery time and intracytoplasmic sperm injection (ICSI) outcomeamong patients underwent anesthesia with fentanyl, remifentanil or alfentanil.Material and methods:This randomized double-blinded clinical trial was conducted in patients under-going anesthesia for transvaginal ultrasound guided oocyte retrieval (TUGOR). Patients were randomlyallocated to alfentanil (A; 15mg/kg), fentanyl (F; 1.5mg/kg) or remifentanil (R; 1.5mg/kg) groups.

Results:Three hundred forty patients were assessed for eligibility and randomized for transvaginaloocyte retrieval following general anesthesia and 105 were lost to follow up. No statistically significantdifferences were noted among groups regarding basic characteristics. Although, time to respond to verbalcommand was significantly different among groups (A: 1.99±1.64, F: 2.56±1.72, R: 1.78±1.34,P¼0.014). There were no significant differences among groups with respect to thefirst and secondpostoperative pain intensity, patient satisfaction, pre-induction and post-induction systolic and diastolicblood pressure (BP). Terminal systolic (A: 101.61±9.15, F: 105.29±12.61, R: 102±12.91, P¼0.01) anddiastolic (A: 59.97±9, F: 65.63±9.13, R: 63.69±11.01, P¼0.003) BP was significantly different amonggroups. The fertilization rate was significantly different among groups (A: 51.6%, F: 54.4%, R: 62.2%,P¼0.018). Implantation rate, biochemical and clinical pregnancy rate was similar among groups.

Conclusions:The results of present study demonstrated that all three opioids have the same efficiency, inregards to patient satisfaction and pregnancy outcome. However, Anesthesia with alfentanil comparedwith fentanyl and remifentanil, seems to be inferior for TUGOR due to higher effect on fertilization rateand less hemodynamic stability.

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مولف : دکتر مرضیه مهرافزا، دکتر احمد حسینی و حوا دشتدار
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