RESUMO
Objective To evaluate the clinical anesthetic efficacy of a combination of propofol and remifentanil for ultrasound-guided transvaginal oocyte retrieval.Pharmacodynamic (PD) model was established and its characteristics were analyzed based on the simulated concentrations of propofol and remifentanil in respective pharmacokinetic models, so as to guide further study.Methods Forty-two female patients undergoing transvaginal oocyte retrieval were divided into groups PR15 (n=24) and PR10 (n=18), who were received intravenous bolus of remifentanil 1.5 μg/kg + propofol 1.5 mg/kg and remifentanil 1.0 μg/kg+propofol 1.0 mg/kg, respectively.The anesthesia quality evaluation was based on the following indicators: onset time (loss of eyelash reflex), recovery time of orientation, the incidence of hypoxemia (SpO2 < 92%) and adverse reactions.Nonlinear mixed-effects model was used to evaluate the time courses of the simulated propofol and remifentanil concentrations-effect and to establish the PD model with NONMEM software.Results The time of recovering orientation in the patients of group PR10 was significantly faster compared with the patients in group PR15;the time of loss of eyelash reflex , incidence of hypoxemia (12.5% vs 16.7%) and cough (16.7% vs 11.1%) had no significant differences between the both groups.With the final PD model, the estimated parameters as following: EC50 of propofol and remifentanil for effective sedation and analgesia were 1.71 μg/ml and 2.57 ng/ml, respectively.EC95 of propofol and remifentanil for effective sedation and analgesia were 4.30 g/ml and 4.57 ng/ml, respectively.The effect site concentration of propofol 1 mg/kg was lower than EC50, but the effect site concentration of 1.5 mg/kg was higher than EC50.The peak effect site of 1.0 μg/kg and 1.5 μg/kg remifentanil was higher than EC50, and 1.5 μg/kg concentration was close to EC95.Conclusion Based on patients' recovery time, propofol 1.0 mg/kg combined with fentanyl 1.0 μg/kg is appropriate in patients undergoing transvaginal oocyte retrieval.