Is propofol a proper proposition for reproductive procedures

Propofol is a very widely used medication. In only a few years of market presence in the U.S.A. propofol has all but displaced the barbiturates as induction drugs. Publications that testify to its usefulness abound in virtually every area of anesthesia. Among propofol’s many undisputed advantages is its rather short, context-sensitive half-life. Even maintenance of anesthesia with propofol infusions has been advocated as offering significant advantages.’ The widespread use suggests that knowingly and unknowingly propofol has been used in a large number of pregnant women. We suspect that it has been given to women during all phases of pregnancy, from the time surrounding conception to delivery. Yet, to date, no studies for determining its teratogenic potential can be located in the published literature. We may evaluate propofol’s effect vicariously on uterine blood flow and fetal hemodynamics. We know that drug-induced decreases in uterine blood flow cause fetal hypoxia, which may in turn be related to teratogenicity. In pregnant ewes near term, Alon el aZ.* demonstrated that propofol caused no decreases in uterine blood flow and lacked adverse effects on fetal cardiovascular or acid-base status. According to the Food and Drug Administration (FDA) use-in-pregnancy rating, which ranges from A (controlled studies show no fk or, zy no adequate human studies have been done, animal findings are negative). Among the other intravenous (IV) anesthetic drugs, only methohexital has earned a “B” grade, while thiopental sodium, etomidate, and ketamine, as well as the opioids fentanyl, alfentanil, and sufentanil, are all classified as “C” (risk cannot be ruled out). Midazolam is labeled “D” (positive evidence of risk. Investigational or postmarketing data show risk to the fetus. Nevertheless, potential benefits may outweigh the potential risk.)3 With this knowledge, and given the task of choosing an anesthetic for a pregnant patient, an anesthesiologist is likely to opt for propofol. But what do we really know about propofol’s effects on human reproduction? Beginning to shed some light on this topic, Rosenblatt et al., in this issue of the Joumzal of Clinical Anesthesia, compare a propofol-based sedation technique with a non-propofol regimen in a unique group of 106 patients4 Oocytes harvested from healthy women were fertilized and transferred to infertile women. Propofol (or not) was given to the donors during oocyte harvest but no medication was