Transvajinal ultrason eşliğinde oosit toplama işleminde anestezi yönetimi: Mini derleme

Öz

Oosit toplama işlemlerinde anestezi/analjezi yönetimi, in vitro fertilizasyon tedavisinde hasta konforunun, güvenliğinin ve prosedürel başarının sağlanmasında çok önemli bir rol oynamaktadır. Bu mini derleme, transvajinal ultrason eşliğinde oosit toplanması planlanan hastalarda bilinçli sedasyon, rejyonal anestezi veya genel anestezi yoluyla bireysel hasta ihtiyaçlarına göre yeterli analjezi ve konfor sağlamak için işlem öncesi/işlem sırasındaki hususları, anestezi tekniklerinin ve anestezik ilaçların seçimini ele almaktadır. Klinisyenler anestezi tekniklerini seçerken hastanın komorbiditelerini, ilaç kullanımlarını ve prosedürel gereklilikleri göz önünde bulundurmalıdır.

Anahtar Kelimeler

• oosit toplama
• anestezi
• analjezi
• sedasyon
• in vitro fertilizasyon

Anesthesia Management in transvaginal ultrasound guided oocyte retrieval procedure: A mini review

Öz

Anesthesia/analgesia management in oocyte retrieval procedures plays a pivotal role in ensuring patient comfort, safety, and procedural success in in vitro fertilization treatment. This mini review addresses pre-/periprocedural considerations, choice of anesthesia techniques and anesthetic drugs to provide adequate pain relief and comfort tailored to individual patient needs, through conscious sedation, regional anesthesia, or general anesthesia in patients scheduled for transvaginal ultrasound guided oocyte retrieval. Clinicians must consider patient comorbidities, medication history, and procedural requirements when selecting anesthesia techniques.

Anahtar Kelimeler

• oocyte retrieval
• anesthesia
• analgesia
• sedation
• in vitro fertilization

Kaynakça

1. Healy MW, Hill MJ, Levens ED. Optimal oocyte retrieval and embryo transfer techniques: where we are and how we got here. Semin Reprod Med 2015;33(2):83-91.
2. The ESHRE Working Group on Ultrasound in ART, D'Angelo A, Panayotidis C et al. Recommendations for good practice in ultrasound: oocyte pick up(†). Hum Reprod Open 2019; 2019(4): hoz025.
3. Thanikachalam P, Govindan DK. Pain Management during ultrasound guided transvaginal oocyte retrieval - A narrative review. J Hum Reprod Sci 2023;16(1):2-15.
4. Sharma A, Borle A, Trikha A. Anesthesia for in vitro fertilization. J Obstet Anaesth Crit Care 2015; 5(2): 62-72.
5. Guasch E, Gómez R, Brogly N, Gilsanz F. Anesthesia and analgesia for transvaginal oocyte retrieval. Should we recommend or avoid any anesthetic drug or technique? Curr Opin Anaesthesiol 2019;32(3):285-90.
6. Egan B, Racowsky C, Hornstein MD, Martin R, Tsen LC. Anesthetic impact of body mass index in patients undergoing assisted reproductive technologies. J Clin Anesth 2008; 20(5): 356-63.
7. Lew E, Nagarajan S: Anesthetic choices in IVF practice. In: Practical Problems in Assisted Conception, Cheong Y, Li T-C, Tulandi T (eds). Cambridge: Cambridge University Press; 2018: 97-101.
8. Kwan I, Wang R, Pearce E, Bhattacharya S. Pain relief for women undergoing oocyte retrieval for assisted reproduction. Cochrane Database Syst Rev 2018;5(5):CD004829.

9. American Society of Anesthesiologists CoE. Statement on Distinguishing Monitored Anesthesia Care ("MAC") from Moderate Sedation/Analgesia (Conscious Sedation) 2023 [updated October 18, 2023. Available from: https://www.asahq.org/standards-and-practice-parameters/statement-on-distinguishing-monitored-anesthesia-care-from-moderate-sedation-analgesia.
10. Tewari S, Bhadoria P, Wadhawan S, Prasad S, Kohli A. Entropy vs standard clinical monitoring using total intravenous anesthesia during transvaginal oocyte retrieval in patients for in vitro fertilization. J Clin Anesth 2016; 34: 105-12.
11. Coskun D, Gunaydin B, Tas A, Inan G, Celebi H, Kaya K. A comparison of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion for oocyte retrieval. Clinics (Sao Paulo) 2011; 66(5): 811-5.
12. Coskun D, Gunaydin B, Tas Tuna A, Celebi H, Kaya K, Erdem A. Bolus fentanyl coadministered with target controlled infusion of propofol for oocyte retrieval. J Reprod Med 2017; 62: 641-6.
13. Morue HI, Raj-Lawrence S, Saxena S, Delbaere A, Engelman E, Barvais LA. Placebo versus low-dose ketamine infusion in addition to remifentanil target-controlled infusion for conscious sedation during oocyte retrieval: A double-blinded, randomised controlled trial. Eur J Anaesthesiol 2018; 35(9): 667-74.
14. Matsota P, Kaminioti E, Kostopanagiotou G. Anesthesia related toxic effects on in vitro fertilization outcome: burden of proof. Biomed Res Int 2015; 2015: 475362.
15. David H. Chestnut CAW, Lawrence C Tsen, Warwick D Ngan Kee, Yaakov Beilin, Jill Mhyre, Brian T. Bateman, Naveen Nathan. Chestnut's Obstetric Anesthesia: Principles and Practice. 6th ed. Elsevier Health Sciences; 2019: 336-49.
16. Haikin Herzberger E, Levy O, Sun B et al. General anesthesia with propofol during oocyte retrieval and in vitro fertilization outcomes: retrospective cohort study. Sci Rep 2023; 13(1): 8021.
17. Gunaydin B, Ozulgen IK, Ozturk E, Tekgul ZT, Kaya K. Remifentanil versus remifentanil with paracervical block on plasma remifentanil concentrations and pulmonary function tests for transvaginal ultrasound-guided oocyte retrieval. J Opioid Manag 2007; 3(5): 267-72.
18. Öztürk E, Günaydin B, Karabacak O et al. Remifentanil infusion and paracervical block combination versus remifentanil infusion alone during in vitro fertilisation (IVF). Turk J Med Sci 2006; 36(2).
19. Vlahos NF, Giannakikou I, Vlachos A, Vitoratos N. Analgesia and anesthesia for assisted reproductive technologies. Int J Gynaecol Obstet 2009; 105(3): 201-5.
20. Azmude A, Agha'amou S, Yousefshahi F et al. Pregnancy outcome using general anesthesia versus spinal anesthesia for in vitro fertilization. Anesth Pain Med 2013; 3(2): 239-42.
21. Humaidan P, Stener-Victorin E. Pain relief during oocyte retrieval with a new short duration electro-acupuncture technique-an alternative to conventional analgesic methods. Hum Reprod 2004; 19(6): 1367-72.
22. Gejervall AL, Stener-Victorin E, Möller A, Janson PO, Werner C, Bergh C. Electro-acupuncture versus conventional analgesia: a comparison of pain levels during oocyte aspiration and patients' experiences of well-being after surgery. Hum Reprod 2005; 20(3): 728-35.
23. Goutziomitrou E, Venetis CA, Kolibianakis EM et al. Propofol versus thiopental sodium as anaesthetic agents for oocyte retrieval: a randomized controlled trial. Reprod Biomed Online 2015; 31(6): 752-9.
24. Jarahzadeh MH, Jouya R, Mousavi FS, Dehghan-Tezerjani M, Behdad S, Soltani HR. Propofol or thiopental sodium in patients undergoing reproductive assisted technologies: Differences in hemodynamic recovery and outcome of oocyte retrieval: A randomized clinical trial. Iran J Reprod Med 2014; 12(1): 77-82.
25. Zitta M, Mata A, Santiago G, Gómez MH, Sánchez Sarmiento CA, Avendaño C. Deleterious impact of propofol on in vitro fertilization. a prospective randomized trial. Fertil Steril 2013; 100(3): 11.
26. Heytens L, Devroey P, Camu F, Van Steirteghem AC. Effects of etomidate on ovarian steroidogenesis. Hum Reprod 1987; 2(2): 85-90.
27. Buisman E, Roest I, Van der Steeg JW, Smeenk JMJ, Koks CAM. Pain scores during oocyte retrieval for IVF/ICSI: A retrospective cohort study comparing three different analgesia protocols. J Gynecol Obstet Hum Reprod 2022; 51(6): 102394.
28. Swanson RJ, Leavitt MG. Fertilization and mouse embryo development in the presence of midazolam. Anesth Analg 1992; 75(4): 549-54.
29. Roest I, Buisman E, Van der Steeg JW, Koks CAM. Different methods of pain relief for IVF and ICSI oocyte retrieval - A Dutch survey. Eur J Obstet Gynecol Reprod Biol X 2019; 4: 100065.
30. Frederiksen Y, Mehlsen MY, Matthiesen SM, Zachariae R, Ingerslev HJ. Predictors of pain during oocyte retrieval. J Psychosom Obstet Gynaecol 2017; 38(1): 21-9.
31. Tuna AT, Kocayigit H, Demir G et al. Investigation of apoptotic effect of propofol, dexmedetomidine and medetomidine on oocyte cumulus granulosa cells in rats. JARSS 2023; 31(1): 50-4
32. Al-Sirsi MH, Abu al-Ghar WM, Maklid AK. The emergence profile of propofol sedation compared with dexmedetomidine injection during ultrasound-guided oocyte pickup for in-vitro fertilization. Ain-Shams J Anaesthesiol 2015; 8(3): 327-33.
33. Elnabtity AM, Selim MF. A prospective randomized trial comparing dexmedetomidine and midazolam for conscious sedation during oocyte retrieval in an in vitro fertilization program. Anesthest Essays Res 2017; 11(1): 34-9.
34. Gernez E, Lee GR, Niguet JP, Zerimech F, Bennis A, Grzych G. Nitrous oxide abuse: Clinical outcomes, pharmacology, pharmacokinetics, toxicity and impact on metabolism. Toxics 2023; 11(12).
35. Hadimioglu N, Aydogdu Titiz T, Dosemeci L, Erman M. Comparison of various sedation regimens for transvaginal oocyte retrieval. Fertil Steril 2002; 78(3): 648-9.
36. Szyfter K, Szulc R, Mikstacki A, Stachecki I, Rydzanicz Mg, Jaloszynski P. Genotoxicity of inhalation anaesthetics: DNA lesions generated by sevoflurane in vitro and in vivo. J Appl Genet 2004; 45(3): 369-74.
37. Zhang L, Zhang Y, Hu R et al. Isoflurane inhibits embryonic stem cell self-renewal and neural differentiation through miR-9/E-cadherin signaling. Stem Cells Dev 2015; 24(16): 1912-22.
38. Chai D, Cheng Y, Jiang H. Fundamentals of fetal toxicity relevant to sevoflurane exposures during pregnancy. Int J Dev Neurosci 2019; 72: 31-5.
39. Orak Y, Tolun Fİ, Bakacak M et al. Effects of propofol versus sevoflurane on postoperative pain and neuroendocrine stress response in oocyte pickup patients. Pain Res Manag 2021; 2021: 1-9.
40. Grossman LC, Michalakis KG, Browne H, Payson MD, Segars JH. The pathophysiology of ovarian hyperstimulation syndrome: an unrecognized compartment syndrome. Fertil Steril 2010; 94(4): 1392-8.
41. Binder H, Dittrich R, Einhaus F et al. Update on ovarian hyperstimulation syndrome: Part 1--Incidence and pathogenesis. Int J Fertil Womens Med 2007; 52(1): 11-26.
42. Buisman E, Grens H, Wang R et al. Trends in research on pain relief during oocyte retrieval for IVF/ICSI: a systematic, methodological review. Hum Reprod Open 2022; 2022(1): hoac006.
43. Kailasam C, Hunt LP, Ryder I, Bhakri I, Gordon UD. Safety and effectiveness of diclofenac sodium in assisted reproduction treatment: a randomized prospective double-blind study. Reprod Biomed Online 2008; 16(5): 724-9.
44. Kaya K, Ozturk E, Tuncer B, Gunaydin B. Remifentanil infusion and paracervical block combination for transvaginal ultrasound guided oocyte retrieval. Turk J Med Sci 2005; 35: 99-105.