[Comparison of 4 anesthetic techniques for in vitro fertilization]

Little is known of the effect on oocytes of anesthesia administered during retrieval. The main objective of this study was to compare the prolactin and stress hormone responses to surgical stimulus under 4 anesthetic techniques and to determine whether there is an effect of technique on the number and quality of oocytes retrieved.

METHODS

We designed a clinical trial to determine the plasma and follicular levels of prolactin and cortisol in patients in an assisted reproduction program. The patients were randomized to 3 anesthetic groups: general anesthesia, spinal anesthesia, or sedation with alfentanil and midazolam plus paracervical block. Patients were consecutively assigned to the fourth group to receive sedation with remifentanil plus paracervical block.

RESULTS

We studied 90 patients. The patients receiving general anesthesia had the greatest increase in prolactin by the end of the procedure. Follicular cortisol increased in the paracervical block group in which remifentanil was used for sedation. The only significant difference between groups was seen for the rate of gestation of 0% in the group receiving sedation with alfentanil and midazolam before a paracervical block. Adverse effects were few with all the techniques. All patients reported a high degree of satisfaction.

CONCLUSIONS

Plasma increases in prolactin and hormonal responses to follicular puncture were fully attenuated by spinal anesthesia and partially attenuated by the techniques requiring sedation. None of the anesthetic techniques proved harmful to oocytes or embryos. Nor was the effectiveness of the in vitro fertilization technique affected by any of the anesthetic techniques studied.

[Amniotic fluid embolism: review]

The amniotic fluid embolism, is a very uncommon syndrome but because of its severity and high mortality, it is interesting to study and to get a deep knowledge of its etiopathogenia and physiopathology. In this article, we revise the actually purposed pathogenic mechanisms, specially the humoral mechanisms in front of mechanical, as it was defended a few years ago. The diagnostic of this syndrome, is an interesting question, because it is not only pathology, actually it trends to immunologic diagnosis. The amniotic fluid embolism, interests to anesthesiologist and its differences in cardiopulmonary resuscitation in the pregnant woman too. All these data are discussed in our article, as much as treatment, that is based upon haemodinamics and cardiopulmonary resuscitation.

[Cardiac hypertrophy associated with subaortic obstruction induced by adrenocorticotropic hormone treatment]

A 7 months-old child affected of West syndrome presented a cardiac hypertrophy with subaortic obstruction induced by adrenocorticotropic hormone treatment. The administration of this hormone may induce a Cushing syndrome; at high doses has chronotropic and inotropic positive effects and may produce arterial hypertension and cardiac hypertrophy. We pointed out the importance of the echocardiography-Doppler in the diagnosis and follow-up of the cardiac hypertrophy with subaortic obstruction as well as the reversibility of the cardiac involvement when the drug is suppressed.