Anaesthesia for IVF Soroka Medical Center, Beer-Sheva,Israel 2004 Dr. Vilcu Elena. - презентация

1 Anaesthesia for IVF Soroka Medical Center, Beer-Sheva,Israel 2004 Dr. Vilcu Elena

2 Introduction In developed nations 5-10% of births are preterm and if IVF is the cause of less than 1% of all the births and it is the cause of 7% of very preterm babies. In developed nations 5-10% of births are preterm and if IVF is the cause of less than 1% of all the births and it is the cause of 7% of very preterm babies.

3 Indications: Absence of both fallopian tubes Irreversible tubal blockage, Infertility related to lowered sperm count, motility, or function Immunological infertility Infertility due to defects in cervical function Other causes of infertility, including endometriosis and unexplained infertility.

4 There are five major steps in the IVF and embryo transfer sequence: Monitor the development of ripening egg(s) in the ovaries. Monitor the development of ripening egg(s) in the ovaries. Collect eggs. Collect eggs. Obtain sperm. Obtain sperm. Put eggs and sperm together in the laboratory, and provide correct conditions for fertilization and early embryo growth. Transfer embryos into the uterus. Transfer embryos into the uterus.

5 Collect eggs technics: Ultrasound Directed Oocyte Retrieval (UDOR) Trans Vaginal Follicle Aspiration (TVFA)

6 For UDOR, the main anaesthetic options available are IV sedation and regional anaesthesia. It is important to remember that patients It is important to remember that patients for UDOR are Day care cases and the basic principles of Ambulatory anaesthesia apply. for UDOR are Day care cases and the basic principles of Ambulatory anaesthesia apply.

7 Effects of anaesthetic agents and CO2 on ART Halothane and neuroleptanaesthesia have been studied and it is inferred that both are not to be used for ART procedures. The use of GA with N2O for UDOR has an adverse outcome on the outcome of IVF; the deleterious effect manifests itself only after embryo transfer and leads to lower pregnancy and delivery rates Exposure to pneumoperitoneum with 100% CO 2 adversely affects oocyte quality and in combination with exposure to GA with N2O appear to affect fertilization and cleavage in vitro.

8 Effects of anaesthetic agents on ART Remifentanyl based GA without N2O is a suitable alternative to sedation and may be recommended for IVF-UDOR if GA is required. Propofol has been a promising alternative for Thiopental for short surgical procedures and has been tried for UDOR also, but it should be used with caution, despite its advantages. Propofol, has been suspected of damaging oocytes. Concentrations of propofol have been shown to increase in follicular fluid with time, during oocyte retrieval. been shown to increase in follicular fluid with time, during oocyte retrieval.

9 Effects of anaesthetic agents on ART Midazolam/Remifentanyl regimen was evaluated to be as effective and safe as propofol/fentanyl regimen. It is advisable that the IVF procedure should be kept as short as possible in order to limit the accumulation of the anaesthetic in the follicular fluids. NB. Electro-acupressure (EA) : EA was compared with alfentanyl infusion for UDOR and was found to be a good alternative for conventional anaeshtesia. NB. Electro-acupressure (EA) : EA was compared with alfentanyl infusion for UDOR and was found to be a good alternative for conventional anaeshtesia.

10 Regional/Local anaesthesia UDOR was performed rapidly and accurately in a study under local anaesthesia and the acceptance was excellent in majority of the patients. Epidural anaesthesia, the most popular of the obstetric anaesthetic techniques offers no obvious advantages over the IV sedation or the other methods.

11 Experience. In the course of staging I had observed 10 cases of anaesthesia for IVF.The age of patients was years, the weight kg.. In all of these cases general anaesthesia it was applicated with the spontaneous breathing via masca.

12 We used the following medication: We used the following medication: Midazolam (0,05mg/kg) + propofol (2- 3 mg/kg) - 3 Propofol (2-3mg/kg) + fentanyl (0,05mg/kg) - 5 Ketalar (20mg/kg) + propofol (2- 3 mg/kg) - 2

13 conclusion: conclusion: The propofol + fentanyl anesthesia it seem be very efficacious and safe for this type of procedure. The propofol + fentanyl anesthesia it seem be very efficacious and safe for this type of procedure.