Comparison of the Effects of Two Different Remifentanil Infusion Dosage Used In Sedation during In-Vitro Fertilization Procedure

Introduction: In vitro fertilization (IVF) is an uncomfortable, painful procedure which requires analgesia and anesthesia.Aim: The aim of the study is to compare the level and hemodynamic effects of sedation, patient and physician satisfactions following sedation induction via two different infusion dosages of remifentanil (R) and additional bolus propofol infusions.Methods: Approval of the Local Ethical Committee was obtained and a double blind prospective randomized study is performed on ASA I-II 86 female patients aged between 18 and 40 years that undergo IVF. Patients were divided into two groups as R1 and R2. Basal measures, heart rate (HR), mean arterial pressure (MAP), arterial oxygen saturation (SPO2), respiration rate (RR) and Ramsay sedation scores (RSS) are noted. Group R1 received 0.1 µg.kg-1.min-1 while Group R2 received 0.15 µg.kg-1.min-1 remifentanil infusion. 1 mg/kg propofol bolus infusion is administered intravenously at second minute of remifentanil infusions. Sedation was maintained for subjects to have a RSS of 3 to 4. HR, MAP, SPO2, RR, RSS, SAP, DAP, side effects, applied remifentanil and propofol doses, SAB, DAB values were recorded from the beginning of remifentanil infusion to the end of IVF procedure at every two minutes for first 10 minutes and every five minutes there after. Postanesthesic Awakening Scores according to Postanesthetic Modified Alderete Scores (PMAS) were noted in postoperative period. Fertilization, cleavage and pregnancy rates together with pregnancy prognoses were compared.Results: There were no statistically significant differences in HR and MAP as hemodynamic parameters among groups (p>0.05). Desaturation and hypopnea were found to be more often in R2, which is not statistically significant (p>0.05). Whereas apnea (p<0.05) was observed more often in R2. Respiratory support need was observed more in R2 (p<0.05). There was not statistically significant difference among groups in discharge scores according to PMAS. Mean awakening scores of the patients yielded that patients were ready for discharge after 8-minutes. When satisfaction levels were compared among groups, it was observed that anesthesiologist?s satisfaction was superior in R1 (p>0.05) where as surgeon?s satisfaction was superior in R2 (p<0.05). Both patient groups revealed good satisfaction levels (p>0.05). Total remifentanil dose was higher in R2 (p<0.05) where as propofol dose used was higher in R1 , which is not statistically significant (p>0.05). There were no differences among groups in fertilization, cleavage and pregnancy rates together with pregnancy prognoses (p>0.05).Discussion: 0.1µg.kg-1.min-1 infusion dose of remifentanil for sedation produced better respiratory results. Both remifentanil doses maintained stabile hemodynamics and enabled fast, uncomplicated recovery.Conclusion: We believe that remifentanil propofol combination can be safely used in day care procedures.Keywords: In vitro fertilization, sedation, propofol, remifentanilComparison of the Effects of Two Different Remifentanil Infusion Dosage Used In Sedation during In-Vitro Fertilization ProcedureHuriye Begburs Sarikaya, Dokuz Eylul University Faculty of Medicine, Anesthesiology and Reanimation DepartmentIntroduction: In vitro fertilization (IVF) is an uncomfortable, painful procedure which requires analgesia and anesthesia.Aim: The aim of the study is to compare the level and hemodynamic effects of sedation, patient and physician satisfactions following sedation induction via two different infusion dosages of remifentanil (R) and additional bolus propofol infusions.Methods: Approval of the Local Ethical Committee was obtained and a double blind prospective randomized study is performed on ASA I-II 86 female patients aged between 18 and 40 years that undergo IVF. Patients were divided into two groups as R1 and R2. Basal measures, heart rate (HR), mean arterial pressure (MAP), arterial oxygen saturation (SPO2), respiration rate (RR) and Ramsay sedation scores (RSS) are noted. Group R1 received 0.1 µg.kg-1.min-1 while Group R2 received 0.15 µg.kg-1.min-1 remifentanil infusion. 1 mg/kg propofol bolus infusion is administered intravenously at second minute of remifentanil infusions. Sedation was maintained for subjects to have a RSS of 3 to 4. HR, MAP, SPO2, RR, RSS, SAP, DAP, side effects, applied remifentanil and propofol doses, SAB, DAB values were recorded from the beginning of remifentanil infusion to the end of IVF procedure at every two minutes for first 10 minutes and every five minutes there after. Postanesthesic Awakening Scores according to Postanesthetic Modified Alderete Scores (PMAS) were noted in postoperative period. Fertilization, cleavage and pregnancy rates together with pregnancy prognoses were compared.Results: There were no statistically significant differences in HR and MAP as hemodynamic parameters among groups (p>0.05). Desaturation and hypopnea were found to be more often in R2, which is not statistically significant (p>0.05). Whereas apnea (p<0.05) was observed more often in R2. Respiratory support need was observed more in R2 (p<0.05). There was not statistically significant difference among groups in discharge scores according to PMAS. Mean awakening scores of the patients yielded that patients were ready for discharge after 8-minutes. When satisfaction levels were compared among groups, it was observed that anesthesiologist?s satisfaction was superior in R1 (p>0.05) where as surgeon?s satisfaction was superior in R2 (p<0.05). Both patient groups revealed good satisfaction levels (p>0.05). Total remifentanil dose was higher in R2 (p<0.05) where as propofol dose used was higher in R1 , which is not statistically significant (p>0.05). There were no differences among groups in fertilization, cleavage and pregnancy rates together with pregnancy prognoses (p>0.05).Discussion: 0.1µg.kg-1.min-1 infusion dose of remifentanil for sedation produced better respiratory results. Both remifentanil doses maintained stabile hemodynamics and enabled fast, uncomplicated recovery.Conclusion: We believe that remifentanil propofol combination can be safely used in day care procedures.Keywords: In vitro fertilization, sedation, propofol, remifentanil