Sevoflurane Versus Propofol; Neuro Endocrine Response in Patients of Oociyt Pick up
Condition: Anesthesia; Infertility; Pain, Postoperative; Stress, Psychological
MeSH terms: Infertility; Pain, Postoperative; Stress, Psychological
Study type: Observational

Summary: 
      Patients in the study will be grouped as 1st group Propofol, 2nd Group
      Sevofluran.Preoperative blood will be taken from the patients and cortisol, acth, glucagon,
      aldosterone, PGE2, CRH will be studied. During the operation, the patient's systolic blood
      pressure, diastolic blood pressure, mean arterial pressure, heart rate, oxygen saturation
      will be followed. Analgesia will be provided according to the body movements of the patient
      and VAS measurement will be performed. The patient's pain will be assessed by the VAS (Visuel
      Analogue Scale) scoring system and during the first hour postoperatively after the patient's
      consciousness is complete . Hormones such as cortisol, acth, glucagon, aldosterone, PGE2, CRH
      will be studied biochemically in the follicular fluid and blood of the patient
      postoperatively. The aim of in the study is to compare the effect of propofol and sevoflurane
      routinely applied in IVF centers on postoperative pain scores and stress hormones in blood
      and follicular fluid in a painful and stressful application of egg collection
    

Detailed description: 
      In vitro fertilization (IVF) is the technique that allows male and female sperm and egg
      fertilization to occur outside the female body, and is the most common assisted reproductive
      technique. Collection of eggs (oocytes) from female ovaries is called oocyte pick-up (OPU) in
      the process. Initially started to be implemented towards the end of 1970. In the last 30
      years, the number of infertile couples has been increasing and trying to have children with
      in vitro fertilization techniques. Different anesthetic agents are used for the oocyt pick-up
      procedure. Studies have shown that anesthetic agents are detected in follicular fluid. Animal
      and human studies indicate that anesthetic agents may negatively affect the development of
      oocytes and embryos. However, the possible effects of anesthetic drugs on oocyte physiology
      and embryo development have not yet been sufficiently investigated. Currently, the possible
      effects of different anesthetic agents on the oocyte are discussed. In one study, the highest
      number of oocytes per patient and the lowest number of mature oocytes in the thiopental
      sodium and sevoflurane groups were determined. On the other hand, there are studies showing a
      marked increase in 1PN and 3PN oocytes when there is a decrease in normal fertilized oocytes
      in the propofol group. These results suggest that oocyte cytoskeleton may be an effect of
      propofol. It is known that propofol is detected in human follicular fluid. In addition,
      harmful effects on division and fertilization were shown in mouse models. Despite this,
      propofol is one of the most commonly used agents. In another study showed that , sevoflurane
      has a genotoxic effect on hamster ovay cell. However, when another group performed the same
      tests to test propofol genotoxicity effects were not found. Patients feel anxiety before
      oocyte processing, and sometimes feel severe pain during the procedure. Surgical procedures
      and interventional procedures applied to the disease are characterized by pain, neurohumoral,
      immunologic, metabolic changes resulting in a complex stress response. The magnitude of the
      resulting stress response depends on various factors such as the severity and duration of the
      surgical trauma, patient age, peroperative and postoperative pain, anesthetic method and
      surgical technique. Even if adequate analgesia is provided in the egg collection process, the
      patients usually feel pain in the peroperative and postoperative period. It has been reported
      that these changes induced by stress in the literature may lead to complications in
      perioperative and postoperative period. Many studies in the literature have indicated that
      the choice of anesthetic agent may affect stress response by stimulating, inhibiting, and
      alleviating pathophysiological pathways leading to neurohumoral and immunological changes.
      The effects of sevoflurane and propofol anesthesia on the surgical trauma on the neurohumoral
      response have been investigated, but some aspects have not yet been clarified. Patients in
      the study will be grouped as 1st group Propofol, 2nd Group Sevofluran.Preoperative blood will
      be taken from the patients and cortisol, acth, glucagon, aldosterone, PGE2, CRH will be
      studied.During the operation, hemodynamics (systolic blood pressure, diastolic blood
      pressure, heart rate, mean arterial pressure, oxygen saturation) will be recorded during the
      operation at 1,3,5,7,10,15 minutes. Additional analgesic and anesthesia requirements and body
      movements will be recorded during the operation. Analgesia will be provided according to the
      body movements of the patient and VAS measurement will be performed. The patient's pain will
      be assessed by the VAS (Visuel Analogue Scale) scoring system and hemodynamic parameters
      (systolic blood pressure, diastolic blood pressure, heart rate, mean arterial pressure,
      oxygen saturation) during the first hour (1 mınute,5. minute, 15. minute,30. minute, 60.
      minute) postoperatively after the patient's consciousness is complete .Analgesic (Naproxen
      Sodium) will be administered when the pain score (VAS) is 5 or greater than 5. Hormones such
      as cortisol, acth, glucagon, aldosterone, PGE2, CRH will be studied biochemically in the
      follicular fluid and blood of the patient postoperatively. The aim of the study is to compare
      the effect of propofol and sevoflurane routinely applied in IVF centers on postoperative pain
      scores and stress hormones in blood and follicular fluid in a painful and stressful
      application of egg collection. In this study, two different anesthetic agents administered
      with propofol and sevoflurane will be used to compare the peroperative analgesic consumption
      and postoperative pain levels. At the same time, it will be determined which anesthetic agent
      is suitable for oocyte collection by looking at the neurohumoral stress hormones in blood and
      follicular fluid. The findings will be evaluated statistically.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients between the ages of 18 and 40 who have undergone IVF practice constitute the
        patient population.