Alexander Ioscovich1, Talia Eldar-Geva2, Marina Weitman1, Gheona Altarescu3, Alina Rivilis4, Deborah Elstein5. 1. Department of Anesthesia, Shaare Zedek Medical Center (affiliated with the Hebrew University-Hadassah Medical School), Jerusalem, Israel. 2. IVF Unit, Shaare Zedek Medical Center (affiliated with the Hebrew University-Hadassah Medical School), Jerusalem, Israel. 3. IVF Unit, Shaare Zedek Medical Center (affiliated with the Hebrew University-Hadassah Medical School), Jerusalem, Israel ; Medical Genetics Institute, (affiliated with the Hebrew University-Hadassah Medical School), Jerusalem, Israel ; ZOHAR PGD Lab, Shaare Zedek Medical Center (affiliated with the Hebrew University-Hadassah Medical School), Jerusalem, Israel. 4. Private Statistical Consultant, Toronto, Canada. 5. Department of Obstetrics and Gynecology, Shaare Zedek Medical Center (affiliated with the Hebrew University-Hadassah Medical School), Jerusalem, Israel.
Abstract
PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Entities:
Keywords:
Autosomal dominant diseases; general anesthesia; in vitro fertilization; maternal outcome; neonatal outcome; pre-implantation genetic diagnosis; recovery time
Authors: William J Groh; Miriam R Groh; Chandan Saha; John C Kincaid; Zachary Simmons; Emma Ciafaloni; Rahman Pourmand; Richard F Otten; Deepak Bhakta; Girish V Nair; Mohammad M Marashdeh; Douglas P Zipes; Robert M Pascuzzi Journal: N Engl J Med Date: 2008-06-19 Impact factor: 91.245