経膣超音波検査卵子回収（TUGOR）のための麻酔薬としてのレミフェンタニルとプロポフォールの併用または非併用による妊娠と麻酔成績への影響。無作為化対照試験

Remifentanil with or without Propofol as Anesthesia Agents for Trans-Vaginal Ultrasonography Oocyte Retrieval (TUGOR) on Pregnancy and Anesthesia Outcomes: A Randomized Controlled Trial.

• Simin Atashkhoei
• Khadijeh Pouya
• Parvin Hakimi
• Raana Zakeri
• Nasrin Soltanzadeh
• Pouya Hatami-Marandi

抄録

背景:

BACKGROUND: Transvaginal Ultrasound-Guided Oocyte Retrieval (TUGOR) is a painful procedure, which often requires the application of anesthesia agents. There is a controversy in the literature about the effects of administrated anesthetics for TUGOR on patients & pregnancy outcomes.

目的:

本研究では、TUGORのために投与したレミフェンタニルとプロポフォールの併用と非併用の麻酔薬の妊娠・麻酔成績への影響を比較することを目的とした。

OBJECTIVE: The current study aimed to compare the effects of remifentanil with or without propofol, administrated for TUGOR, on pregnancy and anesthesia outcomes.

方法:

二重盲検無作為化比較試験では、18～40歳のTUGOR手術候補者180名が対象となった。全女性に麻酔導入剤としてミダゾラム0.03mg/kgとレミフェンタニル1ug/kgを投与し、その後、麻酔維持の観点から、介入群にレミフェンタニル0.25μg/kg/min、対照群にレミフェンタニル1ug/kg/min、プロポフォール50～150ug/kg/minを投与する等身大の2つの群に無作為に割り付けた。血行動態症状、副作用を含む手術成績、妊娠成績を試験群間で比較した。本試験はイラン臨床試験登録機関（Iranian Clinical Trials Registry）に登録されており、番号はIRCT201611177013N15。

METHOD: In a double-blind randomized controlled trial, 180 candidates of TUGOR, aged 18-40 years old, were included in the study. All study women received midazolam 0.03 mg/kg and remifentanil 1 ug/kg as anesthesia induction; Later on, they were randomly assigned in two equal size groups in term of anesthesia maintenance, as the intervention group received remifentanil infusion 0.25 μg/kg/min and the control group received remifentanil infusion 1ug/kg/min with propofol 50-150 ug/kg/min. Hemodynamic symptoms, operation outcomes including the side effects, and pregnancy outcomes were compared between the study groups. The study is registered with the Iranian Clinical Trials Registry, number IRCT201611177013N15.

結果:

血行動態症状はレミフェンタニル群で有意に良好な範囲を示したが、手術期間、麻酔期間、回復期間には両群間で有意差はなかった。しかし、手術中および手術後の麻酔副作用は両群間で有意差は認められなかったが、対照群ではより多くの副作用が認められた。生殖成績（採取卵子数、受精卵子数、移植胚数、妊娠率）はレミフェンタニル投与群の方が良好であったが、有意ではなかった。

RESULTS: Although the hemodynamic symptoms showed significantly better ranges in remifentanil group, however, the study groups were not significantly different in durations of operation, anesthesia and recovery. However, the anesthesia side effects during and after the operation were not significantly different between the groups, they were more common in the control one. The reproductive outcomes (numbers of collected oocytes, fertilized oocytes and transferred embryos, pregnancy rates) showed better but non-significant ranges in remifentanil group.

結論:

TUGOR手術では、レミフェンタニルとプロポフォールを比較してレミフェンタニルのみを使用することで、プロポフォールの副作用を押し付けることなく、より良い妊娠成績を得ることができますが、TUGOR手術の麻酔薬としてプロポフォールを使用することは推奨されません。

CONCLUSION: Using remifentanil alone in comparison to remifentanil & propofol in TUGOR procedure can be achieved better pregnancy outcomes without imposing the side effects of propofol; therefore, it is not recommended to use propofol as an anesthesia agent for a TUGOR procedure.

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