Ioscovich Alexander, Eldar-Geva Talia, Weitman Marina, Altarescu Gheona, Rivilis Alina, Elstein Deborah
Department of Anesthesia, Shaare Zedek Medical Center (affiliated with the Hebrew University-Hadassah Medical School), Jerusalem, Israel.
IVF Unit, Shaare Zedek Medical Center (affiliated with the Hebrew University-Hadassah Medical School), Jerusalem, Israel.
J Hum Reprod Sci. 2013 Oct;6(4):263-6. doi: 10.4103/0974-1208.126303.
To date, there has been no comparison of outcomes in women undergoing anesthesia for in vitro fertilization (IVF) oocyte retrieval for the purpose of pre-implantation genetic diagnosis (PGD) because of their or their partner's genetic disease relative to the outcome in women requiring IVF because of fertility issues.
A prospective observational study, wherein all demographic and anesthetic management data were collected from IVF and PGD units' records for a 6-month period. Descriptive analyses and parametric tests were employed.
There were 307 cases IVF and 76 cases PGD: most (97.4% and 99.7%, respectively) received general anesthesia with propofol and fentanyl ± dipyrone (90.5% and 93.3%, respectively) with no adverse effects. The only statistically significant difference between IVF and PGD groups that was potentially clinically significant was post-procedure recovery time (23.0 ± 20.4 vs. 29.4 ± 35.8 min, respectively; P < 0.0001), but is explainable as greater caution by Anesthesiologists for higher-risk PGD cases having autosomal dominant diseases that may impact anesthesia management (myotonic dystrophy, neurofibromatosis, Marfan's); two of these cases also recovered in the general post-anesthesia care unit, as a precaution for early diagnosis and treatment of potential post-procedural complication.
Results of this first-ever survey of anesthesia for PGD compared with IVF cases imply that propofol-and-fentanyl-based anesthesia is safe and can be recommended, bearing in mind that with patients who have autosomal dominant diseases impacting anesthetic management it is prudent to be more cautious post-recovery.
迄今为止，尚未对因自身或伴侣患有遗传病而接受麻醉进行体外受精（IVF）卵母细胞采集以进行植入前基因诊断（PGD）的女性与因生育问题需要IVF的女性的结局进行比较。
一项前瞻性观察性研究，在6个月期间从IVF和PGD单位的记录中收集所有人口统计学和麻醉管理数据。采用描述性分析和参数检验。
有307例IVF病例和76例PGD病例：大多数（分别为97.4%和99.7%）接受丙泊酚和芬太尼±安乃近全身麻醉（分别为90.5%和93.3%），且无不良反应。IVF组和PGD组之间唯一具有潜在临床意义的统计学显著差异是术后恢复时间（分别为23.0±20.4分钟和29.4±35.8分钟；P<0.0001），但这可以解释为麻醉医生对患有可能影响麻醉管理的常染色体显性疾病（强直性肌营养不良、神经纤维瘤病、马凡氏综合征）的高风险PGD病例更加谨慎；其中两例也在全身麻醉后护理病房恢复，作为对潜在术后并发症进行早期诊断和治疗的预防措施。
这项首次对PGD麻醉与IVF病例进行比较的调查结果表明，基于丙泊酚和芬太尼的麻醉是安全的，可以推荐，但要记住，对于患有影响麻醉管理的常染色体显性疾病的患者，恢复后应更加谨慎。
