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Sedation for Maternal-Fetal surgery: Comparison of dexmedetomidine/fentanyl versus diazepam/fentanyl
Abstract Number: F3B-5
Abstract Type: Original Research
Ultrasound guided fetal procedures such as thoracoamniotic shunt placement requires adequate fetal analgesia and immobilization for success. We previously reported diazepam 10mg and fentanyl 200㎍ sufficiently prevented fetal movement in 56% of the cases. However, fentanyl induced maternal respiratory pattern with large diaphragmatic excursion passively moved fetus, which make the procedure challenging. We therefore hypothesized that dexmedetomidine adjunct analgesia may reduce opiate requirement in such procedures.
After institutional review board approval, the medical and anesthesia records of fetal anesthesia were retrospectively reviewed, between January 2015 to December 2017.
The fetuses requiring ultrasound guided diagnostic or therapeutic procedures were reviewed with regard to gestational age, fetal diagnosis, procedure, duration of procedure, dose of anesthetic agents, need for supplemental anesthetic, and maternal side effect.
14 fetuses underwent total of 37 procedure during the study period. There were 8 in the 2nd trimester and 29 in the 3rd. 16 thoracentesis, 11 thoracoamniotic shunts, 7 fetal blood transfusion, 3 peritoneal tap, and 1 peritoamniotic shunt. Dexmedetomidine group consists of 17 procedures in 8 fetuses, while diazepam group consists of 20 procedures 10 fetuses. Duration of procedure in dexmenetomidine group and diazepam group were 45.8±33.7 min and 37.1±18.0, respectively (p value= 0.409). Fentanyl requirement in dexmenetomidine group and diazepam group were 191±98.9㎍ and 167±74.6㎍, respectively (p value= 0.426 ). Thoracoamniotic shut placement is apparently most painful among the studied procedures, but fentanyl requirement was similar between the groups. 3 cases in dexmedetomidine group received diazepam as supplement for fetal immobilization (17.7%), 1 case in diazepam group received intermittent propofol bolus (5.0%). Maternal sedation score in dexmedetomidine group with lower with fewer airway support interventions. Atropine was administered in 5 procedures (4 as treatment of bradycardia and 3 for prophylaxis). Fetal intracardiac epinephrine was needed in 1 fetal transfusion in dexmedetomidine group.
Dexmedetomidine was not associated with decreased fentanyl requirement in this study. Fentanyl may have been required to supplement maternal analgesia in dexmedetomidine group on top of local anesthetic infiltration to abdominal and uterine wall. However, maternal respiratory pattern was more suitable for fetal procedure by omission of diazepam. Maternal and potentially fetal bradycardia warrants caution with dexmedetomidine. Use of epidural analgesia may maximize advantage of dexmedetomidine in fetal procedures.