The comparision of sedo-analgesia with remifentanil and dexmedetomidine in patients undergoing oocyte aspiration procedure

Objective: Trans-vaginal ultrasound guided oocyte retrieval (oocytepick-up-OPU) is an outpatient procedure during which analgesia and immobility are essential for the success of the intervention. During the procedure, the prefence of appropriate anaesthetic agents for sedoanalgesia is essential. In this study, we compared the effects of sedation withr emifentanil and dexmedetomidine on analgesia, sedation level, recovery time and adverse events in patients undergoing OPU. Materials and Methods: After approval of Başkent University, School of Medicine Clinical Ethics and Research Committee, 140 female patients, aged between 30-40 years, were scheduled for this prospective, randomized double-blind study. All patients were enrolled into two groups either to receive dexmedetomidine (Group D) or remifentanil (Group R). All patients were monitorized by pulseoxymeter, ECG and non-invasive blood pressure. Following a bolus dose of propofol 0.5mg/kg iv to all patients, the patients in group R received 0.05 µg/kg iv remifentanil bolus followed by 0.1–0.5 µg/kg/h maintenance infusion of remifentanil. Group D received 0.2 µg/kg iv dexmedetomidine bolus followed by 0.4–2.0µg/kg/h maintenance infusion of dexmedetomidine. OPU procedure was started when the patients attained the sedation level of 4 according to Ramsey Sedation Scale (RSS). If required, additional propofol was administered. Hemodynamic parameters (SAP, DAP, MAP, HR, SpO2) and RSS at time points such as pre-procedure, at first minute and every five minutes afterwards were recorded. The recovery time and adverse events were also noted. Results: Both groups were comparable regarding demographic features and ASA classification. BP values in both groups decreased in comparison to baseline records, however this decrease was statistically more in Group D at the postoperative measurement (p<0.001). HR values at baseline, 5th minutes and postoperative measurements were significantly lowerin Group D (p<0.05). SpO2 values were significantly higher in Group D (p<0.05). Regarding RSS scores, postoperative recovery time and additional propofol consumption, Group D had significantly higher values. All patients in Group R and 15.7% of patients in Group D required analgesic drugs postoperatively (p=0.001). There was no significant difference in time to discharge from the hospital and adverse events between groups (p<0.005). Conclusion: We suggested that dexmedetomidine may provide sufficient anaesthetic safety and comfort with its less systemic and no respiratory depression effects and may present as a valuable alternative to remifentanil during OPU procedures. Key Words: Oocyteretrieval, Dexmedetomidine, Remifentanil, Sedation