Comparison of the effects of 2 different doses of remifentanil infusion for sedation during in-vitro fertilization procedure

To compare the sedation level, hemodynamic effects, patient and physician satisfactions following sedation achieved by 2 different doses of remifentanil [R] infusion with additional bolus infusions of propofol for in vitro fertilization [IVF] procedure. A double-blind prospective randomized study was implemented on 86 ASA I-II grade female patients, 18-40 years of age that underwent IVF procedure. This study was performed in the Department of Anesthesiology and Obstetrics and Gynecology, School of Medicine, Dokuz Eylul University, Izmir, Turkey between November 2006 to August 2008. Group R1 received 0.1mcg/kg/min while Group R2 received 0.15 mcg/kg/min infusion dose remifentanil. Side effects, total doses of remifentanil and propofol administered, heart rate [HR], systolic arterial pressure and diastolic arterial pressure values have been recorded. Fertilization, cleavage, and pregnancy rates together with prognosis of pregnancies were compared. Groups did not show statistically significant differences for hemodynamic parameters of HR and MAP [p=0.281]. Comparison of the satisfaction levels of 2 groups showed that anesthesiologist satisfaction was superior in R1 [p=0.009] whereas surgeon satisfaction was superior in R2 [p=0.01]. Both groups reported good patient satisfaction levels [p=0.31]. There were no differences between the groups in terms of fertilization, cleavage, pregnancy rates and prognosis of pregnancies [p>0.05]. Both doses of remifentanil provided stable hemodynamics along with fast and uncomplicated recovery

Stress Hormones and acid-base status in humanfetuses at term delivery: the effect of delivery method

To evaluate the effect of delivery mode on fetal stress hormones and acid-base status and also to investigate the relationship between fetal acidemia and these hormones. 64 women with term pregnancies were studied. All had singleton, healthy pregnancies. Twenty one women were delivered by spontaneous vaginal route, 23 by vaginal route following oxytocin infusion and 20 by elective caesarean section. Umblical cord blood samples were obtained Immediately following the delivery. Blood gas [pH, pCO2, pO2] and hormonal analysis [Cortisol, dehydroepiandrosterone sulphate, prolactin, and rostenedione] were done in arterial and venous cord blood samples respectively. Higher po2 and prolactin, lower pH levels were found in caesarean section compared to other two groups [p<0.05]. At the time of delivery 11 infants had acidemia [pH <7.20] as judged by pH of umblical arterial blood. Acidemic group had higher cortisol and pCO2 lower pH and po2 levels compared to non-acidemic group [p<0.05]. Method of delivery may affect acid-base and hormonal status of human fetus. Fetal acidemia may alter fetal adrenal steroidogenesis leading to increased fetal cortisol production