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National survey of fetal anesthesia for fetal therapy in Japan
Abstract Number: T3A-4
Abstract Type: Original Research
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.
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.
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%.
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.