Chung P H, Yeko T R, Mayer J C, Vila H, Welden S W, Maroulis G B
Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, USA.
J Reprod Med. 1998 Aug;43(8):681-6.
To investigate the reproductive outcome of laparoscopic gamete intrafallopian transfer (GIFT) performed under epidural vs. general anesthesia.
Retrospective analysis of 110 consecutive laparoscopic GIFT procedures performed under general or epidural anesthesia. All patients underwent controlled ovarian hyperstimulation employing human menopausal gonadotropin and gonadotropin releasing hormone agonist, given either in the midluteal or early follicular phase. Data were retrieved concerning age, diagnosis, estradiol levels and maximum follicular diameter at the time of human chorionic gonadotropin injection, percentage of mature oocytes retrieved and number of oocytes transferred. These variables were compared using the independent means t test. Pregnancy rates and outcome between the general and epidural anesthesia groups were compared with the chi 2 test.
Of the 110 procedures, 84 were performed under general anesthesia, whereas 22 were done using epidural anesthesia. Four procedures started with epidural anesthesia and were converted to general anesthesia because of upper abdominal discomfort. The success rate of epidural anesthesia, therefore, was 85% (22/26). There were no significant differences in the confounding variables between the general and epidural anesthesia groups. However, patients receiving epidural anesthesia had a significantly higher pregnancy rate, 59.1%, and a live birth rate of 40.9% as compared to 31.0% and 21.4%, respectively, for the general anesthesia group.
Laparoscopic GIFT can be performed safely under epidural anesthesia. Because of the higher pregnancy and live birth rates, epidural is the anesthetic of choice for GIFT. However, a prospective, randomized study is needed to confirm the above observation.
探讨在硬膜外麻醉与全身麻醉下进行腹腔镜配子输卵管内移植（GIFT）的生殖结局。
对110例连续在全身或硬膜外麻醉下进行的腹腔镜GIFT手术进行回顾性分析。所有患者在黄体中期或卵泡早期使用人绝经期促性腺激素和促性腺激素释放激素激动剂进行控制性卵巢过度刺激。收集有关患者年龄、诊断、注射人绒毛膜促性腺激素时的雌二醇水平和最大卵泡直径、回收的成熟卵母细胞百分比以及移植的卵母细胞数量的数据。使用独立样本t检验比较这些变量。采用卡方检验比较全身麻醉组和硬膜外麻醉组的妊娠率和结局。
在110例手术中，84例在全身麻醉下进行，22例采用硬膜外麻醉。4例手术开始时采用硬膜外麻醉，因上腹部不适改为全身麻醉。因此，硬膜外麻醉的成功率为85%（22/26）。全身麻醉组和硬膜外麻醉组之间的混杂变量无显著差异。然而，接受硬膜外麻醉的患者妊娠率显著较高，为59.1%，活产率为40.9%，而全身麻醉组分别为31.0%和21.4%。
腹腔镜GIFT可在硬膜外麻醉下安全进行。由于妊娠率和活产率较高，硬膜外麻醉是GIFT的首选麻醉方法。然而，需要进行前瞻性随机研究来证实上述观察结果。
