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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionApplication for ESRA Abstract PrizesBackground and Aims Sedation for oocyte retrieval must provide effective analgesia without respiratory compromise or harm to embryo quality. We compared ketamine-propofol (Ketofol, KP) with ketamine-dexmedetomidine (Ketodex, KD), hypothesising that KD would match analgesia while reducing adverse effects and embryo quality.Methods In a single-centre, open-label, randomised trial, 60 ASA I–II patients (20–40 y) were assigned to KP or KD (30 each). KP received propofol 1 mg kg −1 + ketamine 0.5 mg kg−1, then propofol 3 mg kg−1 h−1. KD received dexmedetomidine 1 µg kg−1 over 10 min + ketamine 0.5 mg kg−1, followed by dexmedetomidine 0.3 µg kg−1 h−1; both regimens included ketamine 0.5 mg kg−1 h−1. Primary outcome was cumulative pain; secondary outcomes were rescue-opioid use, apnoea, postoperative nausea-vomiting (PONV) and embryological indices.Results Median pain scores remained ≤1 in both groups (p > 0.05). Rescue fentanyl was required in 0% KD vs 60% KP (p < 0.001). Apnoea occurred in 0% KD vs 53% KP (p < 0.0001). PONV at 30 min was 3% KD vs 50% KP (p < 0.0001). Fertilisation stayed at 100% in both arms, while day-3 cleavage favoured KD (87 ± 18% vs 78 ± 32%). Haemodynamic variables, satisfaction scores and discharge readiness were comparable.Conclusions Ketodex offers analgesia equivalent to Ketofol yet virtually eliminates opioid need, respiratory depression and early PONV without compromising embryo development. KD is therefore a safe, embryo-friendly alternative for procedural sedation during IVF oocyte retrieval.