Importance of jaw elevation device(JED TM) utilization in in vitro fertilization(IVF) interventions under sedoanalgesia in anesthetic practice

Introduction : IVF is a painful and disturbing interventional procedure and requires anesthesia and analgesia. Upper airway obstruction may occur in varying degrees in patients undergoing this procedure under sedation. Objective: The aim of this study consists of collecting upper airway obstruction occurance, haemodynamic and ventilatory data and validating the effectiveness of the device, on patients undergoing IVF procedure with procedural sedation and analgesia, with or without the use of Jaw Elevaion Device (JEDTM). Material and Method: This study is a retrospective data analysis from outpatient, ASA (American Society of Anesthesiologists) I-II and over 18 years of age, patient files who underwent IVF procedure in our hospital's IVF center between the dates May 2016 and May 2018 after approval from Non-Interventional Research Ethics Committee, Dokuz Eylül University Faculty of Medicine. Patients were separated into two groups, according to JEDTM utilization. Demographics and ASA standart monitorisation data are collected. Upper airway obstruction time and durations and occurances during procedure, applied airway maneuvers and their effectiveness, JEDTM application and alternative airway management data are collected. Results: In our study, data from a total of 130 patients, who underwent oocyte collection procedure under deep sedation is evaluated.In65 of these patients there were JEDTM utilization. Mean age of patients were 32,9, 33.2 and 33.09; mean body mass index values were 25,79, 24,15 and 24,97; in the control group, JEDTM group and total,respectively. ASA risk score distribution was 44 and 39 ASA I patients; 21 and 26 ASA II patients in the control and JED groups, respectively. Upper airway obstruction occurance noted in 32 of the patients in control group and in 30 of the patients in JEDTMgroup. Alternative airway management were employed in 3 and 7 patients in control and JEDTM groups, respectively. Discussion and Conclusion: JEDTMutilization is useful for maintaining an open upper airway during IVF procedures which require a deep sedation plane. However it is necessary to make proper patient selection without head/neck abnormalities and usage under close vigilance/supervision due to the device's "slight" inadequacy / imperfection at maintaining an open upper airway. Keywords: Sedation, Sedoanalgesia, In Vitro Fertilisation, IVF, Jaw Elevation Device, JEDTM