Anesthetic Management in Fetoscopic Surgery and Incidence of Complications

Study Overview
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Brief Summary
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Fetoscopic surgery has been acknowledged to be a reliable procedure to correct several congenital anomalies e.g. shunt insertion in fetal bladder outlet obstruction, laser ablation of vessels in twin-twin transfusion syndrome (TTTS), balloon occlusion in congenital diaphragmatic hernia etc. The technique involves an introduction of small-caliber instruments into the amniotic cavity under ultrasound guidance. This procedure can be successfully done under either general anesthesia, regional anesthesia or local anesthesia with sedation. Each technique has both advantages and drawbacks. Several complications related to anesthetic after fetoscopic surgery can occur. For instance, pulmonary edema which is caused by intravenous fluid loading, irrigation fluid absorption or fluid flow through myometrium venous channel. Besides, maternal hypotension intraoperatively can arise from spinal anesthesia. The aim of the study is to report choice of anesthesia using in fetoscopic surgery in the tertiary care institute (Siriraj hospital) and incidence of complications which may relate to different anesthetic techniques.

Detailed Description
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The quantity and types of medications using in different anesthetic technique will be gathered including opioid, benzodiazepine, propofol, detail of drugs making fetal paralysis, amount of local anesthetic drug in spinal anesthesia etc. Tocolytic drug will also be recorded eg. terbutaline, nifedipine or magnesium sulfate. These drugs have been generally known that may cause hypotension or pulmonary edema. In intraoperative period, the investigators emphasize in the incidence of hypotension and other possible complications such as pulmonary aspiration, failed intubation, maternal desaturation or maternal bradycardia. Volume of intravenous fluid administered and amount of irrigation fluid will also be recorded. Maternal and fetal outcome in recovery room and in postoperative period will be collected.

Official Title
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Anesthetic Management in Fetoscopic Surgery and Incidence of Complications - A Retrospective Review

Conditions
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Fetoscopy, Anesthetic Complications, Pregnancy

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: pregnant women who received intrauterine minimally invasive surgery from the past until 30 Nov 2015 Exclusion Criteria: pregnant women who received intrauterine minimally invasive surgery which was not anesthetized by anesthesiologist.
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Type of anesthetic techniques used in fetoscopic surgery | Type of anesthetic techniques eg. general anesthesia, regional anesthesia, local anesthesia with sedation. | in operating theatre | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Types and quantity of anesthetic medications used | Types and quantity of anesthetic medications used for anesthetize patients in different anesthetic techniques. | in operating theatre | 
| Incidence of complications | Intraoperative complications eg. failed intubation, aspiration, hypotension from spinal anesthesia, high spinal block, desaturation etc. | in operating theatre | 
| Incidence of complications | Complications occurring postoperatively include pulmonary edema, fatal death etc. | after surgery till patients discharge from the hospital | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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fetoscopy, fetal surgery, anesthetic complications