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Restrospective Review of Monitored Anesthesia Care versus General Endotracheal Anesthesia for Non-Cardiac Intrauterine Fetal Interventions
Abstract Number: T2H-542
Abstract Type: Original Research
Fetal intervention is a relatively new field and anesthetic technique per procedure varies by fetal center. Monitored anesthesia care (MAC) has emerged as an alternative to traditional general endotracheal anesthesia (GA), but feasibility and safety have not fully been investigated. This study compares the outcomes of MAC and GA in non-cardiac intrauterine fetal interventions.
All non-cardiac intrauterine fetal intervention cases performed at the Texas Children’s Hospital Pavilion for Women from July 2012 to July 2016 were retrospectively analyzed and categorized by mode of anesthesia. Preoperative patient physical status, number of intraoperative medications required, duration of procedure, and complications were compared between the MAC and GA groups. The number of cases in which mode of anesthesia converted to GA from MAC was also identified.
During the 4-year study period, a total of 512 non-cardiac fetal interventions were performed with 396 under MAC and 116 under GA (Table 1). Average preoperative ASA physical status classification was not found to be statistically significant. The average duration of procedures and number of medications administered between the MAC and GA groups was found to be significant (Table 1). Eight cases (2.02%) in the MAC group required conversion to GA (intubation due to surgical reasons). Out of the 8 conversions, 3 were because of patient inability to lay still for an extended period (due to patient distress (2) and back pain from pregnancy complicated by polyhydramnios (1)). The other 5 conversions were due to changes in surgical plan that required GA. There were 2 complications (intubation during procedure due to anesthetics) in the MAC group (0.51%) compared to 0 complications in the GA group. One of the complications was intubation for airway protection in a patient with persistent nausea and vomiting. The other intubation occurred in a patient with a high spinal block who became unresponsive after vomiting and difficulty breathing.
MAC is a reasonable alternative to GA for fetal intervention. Fetal interventions performed under MAC require less intra-op medication and have a shorter procedure duration as compared to interventions under GA. Our study shows a low complication rate with MAC and GA at .51% and 0%. Given its safety and low complication rate, MAC should be considered as a viable anesthesia option for non-cardiac intrauterine fetal interventions when available.