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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

National survey of fetal anesthesia for fetal therapy in Japan

Abstract Number: T3A-4
Abstract Type: Original Research

Shohei Noguchi Doctor of Medicine1 ; Yuki Ohashi Ph.D.2; Yui Nakano M.D.3; Motoshi Tanaka Ph.D.4; Katsuo Terui Ph.D.5

Objectives

Fetal analgesia and immobilization are often necessary for fetal therapy. However,

the various protocols of fetal analgesia and immobilization are utilized. The aim of

this study was to survey current practice of fetal and analgesia and immobilization

for the first time in Japan.

Methods

We postal surveyed the protocols of maternal and fetal anesthetic management

for fetal therapy during the period between April 2016 and March 2017 at the

institutions of the Japan Society of Fetal Therapy members. The surveyed

therapies were thoracoamniotic shunting, intrauterine transfusion (IUT),

radiofrequency ablation (RFA), fetoscopic laser photocoagulation (FLP) and

fetoscopic tracheal occlusion (FETO). Fetal survey with hysterotomy was excluded

as it has not been performed in Japan.

Results

Among the 97 institutions, 57 (59%) responded to the survey. Of the 57

institutions, 23 institutions (40%) had performed thoracoamniotic shunting,

IUT:37%, RFA:18%, FLP:16% and FETO2%. Anesthesia protocols varied

depending on the fetal therapies. When all the protocols were combined, maternal

anesthesia methods were local anesthesia (27%), sedation/analgesia(S/A) and

local anesthesia (22%), combined spinal epidural anesthesia (20%), general endotracheal anesthesia (12%), S/A epidural anesthesia (8%), epidural anesthesia

alone (6%), and spinal anesthesia (5%).

Fetal anesthesia was provided in 39% of the protocols. The routes of

administration for fetal anesthesia were maternal intravenous or inhalational (IV/IH)

(80%), maternal IV/IH and fetal intramuscular (IM) (8%), fetal IM (4%), maternal

IV/IH and umbilical vein (UV) (4%), and UV alone (4%). Maternal anesthetic agents

were diazepam (21%), remifentanil (21%), fentanyl (18%), propofol (11%),

sevoflurane (11%), dexmedetomidine (11%) and/or pentazocin (4%). Fetal IM

anesthetics were fentanyl and rocuronium (100%). UV anesthetics were fentanyl

(50%) or midazolam (50%). Fetal anesthesia was utilized in 100% of the protocols

for FETO, thoracoamniotic shunting: 61%, IUT:33%, FLP:22%, RFA:10%.

Conclusion

Fetal anesthesia was provided in 39% of the therapies in Japan. The main route

of administration was maternal (80%). Some surgeons replied that they had

finished the procedure without fetal immobility.

Need for and degree of fetal analgesia and immobilization varies depending on

the type of therapies. Current widely varied protocols need to be compared for

better practice for both mother and fetus.

SOAP 2018