Anesthetic Management in Fetoscopic Surgery and Incidence of Complications
Study Details
Study Description
Brief Summary
Fetoscopic surgery has been acknowledged to be a reliable procedure to correct several congenital anomalies e.g. shunt insertion in fetal bladder outlet obstruction, laser ablation of vessels in twin-twin transfusion syndrome (TTTS), balloon occlusion in congenital diaphragmatic hernia etc. The technique involves an introduction of small-caliber instruments into the amniotic cavity under ultrasound guidance. This procedure can be successfully done under either general anesthesia, regional anesthesia or local anesthesia with sedation. Each technique has both advantages and drawbacks.
Several complications related to anesthetic after fetoscopic surgery can occur. For instance, pulmonary edema which is caused by intravenous fluid loading, irrigation fluid absorption or fluid flow through myometrium venous channel. Besides, maternal hypotension intraoperatively can arise from spinal anesthesia.
The aim of the study is to report choice of anesthesia using in fetoscopic surgery in the tertiary care institute (Siriraj hospital) and incidence of complications which may relate to different anesthetic techniques.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
|
Detailed Description
The quantity and types of medications using in different anesthetic technique will be gathered including opioid, benzodiazepine, propofol, detail of drugs making fetal paralysis, amount of local anesthetic drug in spinal anesthesia etc. Tocolytic drug will also be recorded eg. terbutaline, nifedipine or magnesium sulfate. These drugs have been generally known that may cause hypotension or pulmonary edema.
In intraoperative period, the investigators emphasize in the incidence of hypotension and other possible complications such as pulmonary aspiration, failed intubation, maternal desaturation or maternal bradycardia. Volume of intravenous fluid administered and amount of irrigation fluid will also be recorded.
Maternal and fetal outcome in recovery room and in postoperative period will be collected.
Study Design
Outcome Measures
Primary Outcome Measures
- Type of anesthetic techniques used in fetoscopic surgery [in operating theatre]
Type of anesthetic techniques eg. general anesthesia, regional anesthesia, local anesthesia with sedation.
Secondary Outcome Measures
- Types and quantity of anesthetic medications used [in operating theatre]
Types and quantity of anesthetic medications used for anesthetize patients in different anesthetic techniques.
- Incidence of complications [in operating theatre]
Intraoperative complications eg. failed intubation, aspiration, hypotension from spinal anesthesia, high spinal block, desaturation etc.
- Incidence of complications [after surgery till patients discharge from the hospital]
Complications occurring postoperatively include pulmonary edema, fatal death etc.
Eligibility Criteria
Criteria
Inclusion Criteria:
- pregnant women who received intrauterine minimally invasive surgery from the past until 30 Nov 2015
Exclusion Criteria:
- pregnant women who received intrauterine minimally invasive surgery which was not anesthetized by anesthesiologist.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Anesthesiology department, Siriraj hospital, Mahidol University | Bangkok | Thailand | 10700 | |
| 2 | Siriraj Hospital, Mahidol University | Bangkok | Thailand | 10700 |
Sponsors and Collaborators
- Mahidol University
Investigators
- Principal Investigator: Patchareya Nivatpumin, M.D., Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Study Documents (Full-Text)
None provided.More Information
Publications
- De Buck F, Deprest J, Van de Velde M. Anesthesia for fetal surgery. Curr Opin Anaesthesiol. 2008 Jun;21(3):293-7. doi: 10.1097/ACO.0b013e3282fe6e70. Review.
- Deprest JA, Devlieger R, Srisupundit K, Beck V, Sandaite I, Rusconi S, Claus F, Naulaers G, Van de Velde M, Brady P, Devriendt K, Vermeesch J, Toelen J, Carlon M, Debyser Z, De Catte L, Lewi L. Fetal surgery is a clinical reality. Semin Fetal Neonatal Med. 2010 Feb;15(1):58-67. doi: 10.1016/j.siny.2009.10.002. Epub 2009 Nov 13. Review.
- Duron VD, Watson-Smith D, Benzuly SE, Muratore CS, O'Brien BM, Carr SR, Luks FI. Maternal and fetal safety of fluid-restrictive general anesthesia for endoscopic fetal surgery in monochorionic twin gestations. J Clin Anesth. 2014 May;26(3):184-90. doi: 10.1016/j.jclinane.2013.10.010. Epub 2014 May 3.
- Myers LB, Watcha MF. Epidural versus general anesthesia for twin-twin transfusion syndrome requiring fetal surgery. Fetal Diagn Ther. 2004 May-Jun;19(3):286-91.
- Ngamprasertwong P, Habli M, Boat A, Lim FY, Esslinger H, Ding L, Sadhasivam S. Maternal hypotension during fetoscopic surgery: incidence and its impact on fetal survival outcomes. ScientificWorldJournal. 2013 Oct 21;2013:709059. doi: 10.1155/2013/709059. eCollection 2013.
- Robinson MB, Crombleholme TM, Kurth CD. Maternal pulmonary edema during fetoscopic surgery. Anesth Analg. 2008 Dec;107(6):1978-80. doi: 10.1213/ane.0b013e3181891201.
- Rossi AC, Kaufman MA, Bornick PW, Quintero RA. General vs local anesthesia for the percutaneous laser treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2008 Aug;199(2):137.e1-7. doi: 10.1016/j.ajog.2007.12.008. Epub 2008 Mar 20.
- Van de Velde M, Van Schoubroeck D, Lewi LE, Marcus MA, Jani JC, Missant C, Teunkens A, Deprest JA. Remifentanil for fetal immobilization and maternal sedation during fetoscopic surgery: a randomized, double-blind comparison with diazepam. Anesth Analg. 2005 Jul;101(1):251-8, table of contents.
- 150/2558(EC2)