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Anesthesia for Fetal Cardiac Interventions
Abstract Number: S-54
Abstract Type: Original Research
Introduction: Fetal interventions for congenital heart diseases such as aortic or pulmonary stenosis with evolving hypoplastic left heart syndrome (HLHS) have been performed with different types of anesthetic techniques over the past 15 years (1). Mode of anesthesia for fetal surgery at our institution has evolved over time from general anesthesia to neuraxial due to enhanced multi-disciplinary care. The paucity of published data on the maternal and fetal perioperative outcomes under different anesthesia modalities led us to perform a retrospective study.
Methods: We evaluated fetal cardiac surgeries performed at our institution between February 24, 2004 and October 9, 2014. Mode of anesthesia, perioperative maternal and fetal outcomes, length of surgery (LOS), intravenous fluids, opioid usage, incidence of perioperative nausea, vomiting, pruritus (N/V/P), and recovery time were analyzed.
Results: To date, 66 of 130 records were reviewed: 58 percutaneous aortic valvuloplasty for evolving HLHS and 8 percutaneous atrial septostomy for HLHS. Three anesthetics were utilized: 1) GA with spinal with preservative free morphine for postoperative pain (GAWS, n=19), 2) GA alone (GAA, n=20), and 3) Combined spinal epidural or epidural (CSE/E Group, n=27). Maternal complications, anesthetic details, fetal outcomes, and recovery course are listed in the table. The neuraxial technique is linked to less N/V/P, shorter surgical time, less intraoperative fluid and IV opioid use and less maternal airway complications.
Discussion: Our preliminary data show that as the anesthetic method for fetal cardiac interventions transitioned from GA with long acting spinal opioids to neuraxial, fewer side effects such as N/V/P were experienced postoperatively. In the CSE/E group, the shorter surgical time was accompanied by a longer recovery, which is the opposite in the GAWS and GAA groups. Importantly, neuraxial anesthesia afforded the flexibility to pause and resume surgery in cases of fetal malposition, facilitating successful fetal outcomes. Overall, the neuraxial approach avoided maternal airway complications that occurred in some cases of GA, which could result in better maternal safety and satisfaction. Further data collection and analysis will determine if these trends are statistically significant.
(1) Freud LR, Circulation 2014