role of ventilation mode using a laryngeal mask airway during gynecological laparoscopy on lung mechanics, hemodynamic response and blood gas analysis

Background: There are two methods for ventilation in gynecological laparoscopy: volume-controlled ventilation [VCV] and pressure-controlled ventilation [PCV]

Objective: To compare the lung mechanics, hemodynamic response and arterial blood gas analysis and gas exchange of two modes of VCV and PCV using laryngeal mask airway [LMA] at different time intervals

Materials and Methods: Sixty infertile women referred for diagnostic laparoscopy, based on ventilation mode, were randomly divided into two groups of VCV [tidal volume: 10 ml/kg] and PCV. In the PCV group, ventilation was initiated with a peak airway pressure [tidal volume: 10 ml/kg, upper limit: 35 cm H[2]O]. In both groups, the arterial blood samples were taken in several time intervals [5, 10 and 15 min after LMA insertion] for blood gas evaluation. Also the lung mechanics parameters were continuously monitored and were recorded at different time intervals

Results: There were no significant differences for patient's age, weight, height and BMI in two groups. The peak and plateau airway pressure were significantly higher in VCV group compared to PCV group 5 and 10 min after insertion of LMA. PaO[2] was significantly higher after 10 and 15 min in VCV group compared to PCV group [p=0.005 and p=0.03, respectively]. PaCO[2] showed significant increase after 5 min in PCV group, but the differences were not significant after 10 and 15 min in two groups. The end tidal CO2 showed significant increase after 10 and 15 min in VCV compared to PCV group

Conclusion: Both VCV and PCV seem to be suitable for gynecological laparoscopy. However, airway pressures are significantly lower in PCV compared to VCV

Propofol or Thiopental sodium in patients undergoing reproductive assisted technologies: differences in hemodynamic recovery and outcome of oocyte retrieval: a randomized clinical trial

Thiopental sodium and Propofol are two widely-used drugs in the induction of anesthesia in assisted reproductive technology [ART]. However, the side effects and outcome of recovery from anesthesia of these drugs on ART have not been identified yet. This study aimed at investigating the side effects and hemodynamic effects of using thiopental sodium and propofal as well as effects of these drugs on pregnancy outcome in ART cycles. In this double blinded] randomized controlled trial, 90 woman candidate for ART were randomly divided into two groups. 47 patients received Propofol [2.5 mg/kg] and 43 patients received thiopental [5mg/kg] for anesthesia induction. The entry hemodynamic parameters of the patients were documented. During the anesthesia process, hemodynamic parameters were checked at five-minute intervals. The results of the study showed a statistically significant difference between two groups in terms of their response to verbal stimulation [p<0.001], the normalization time of the rate and quality of breathing [p<0.001], nausea [p<0.001], and vomiting [p<0.001]. Also, in comparison with the other group, all these parameters were better in Propofol group. There was found no significant difference between two groups in terms of other variables. Based on the findings of the study, Propofol has fewer known side effects. Vomiting and nausea as two known side effect of anesthesia are significantly lower in patients receiving Propofol than patients who received thiopental

Remifentanil versus fentanyl for assisted reproductive technologies: effect on hemodynamic recovery from anesthesia and outcome of ART cycles

We conducted this study to compare the outcome of assisted reproductive technology [ART] procedures and recovery from anesthesia in women who received opioid analgesia with remifentanil versus fentanyl. This double-blind, randomized clinical trial was carried out in the Yazd Research and Clinical Center for Infertility, Yazd, Iran. We studied 145 women who were participants in an ART program. During the first phase of the study, all patients underwent induction of anesthesia with thiopental and received analgesia with remifentanil or fentanyl. The primary endpoint was pregnancy rate per transfer. The numbers of oocytes collected, fertilized and cleaved were recorded, as was the number of oocytes transferred and recovery profile. In the second phase of the study, all patients were followed for outcome of ART cycle. This study suggested that in women undergoing transvaginal ultrasound-guided oocyte retrieval procedures, the likelihood of a successful pregnancy was higher with a remifentanilbased monitored anesthesia care [MAC] technique than with a fentanyl-based MAC technique. The recovery from anesthesia was significantly better in the remifentanil group versus fentanyl group. The results of this study suggest that remifentanil in clinical practice is superior to fentanyl [Registeration Number: IRCT201009283468N3]