Link: http://www.ncbi.nlm.nih.gov/pubmed/27157206

Rev Bras Anestesiol. 2016 May 3. pii: S0034-7094(16)30026-5. doi: 10.1016/j.bjan.2015.12.010. [Epub ahead of print]
[Fetoscopic tracheal occlusion for severe congenital diaphragmatic hernia: retrospective study].
[Article in Portuguese]
de Assunção Braga AF1, da Silva Braga FS2, Nascimento SP3, Verri B4, Peralta FC5, Bennini Junior J5, Jorge K5.
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Abstract

BACKGROUND AND OBJECTIVES:
The temporary fetal tracheal occlusion performed by fetoscopy accelerates lung development and reduces neonatal mortality. The aim of this paper is to present an anesthetic experience in pregnant women, whose fetuses have diaphragmatic hernia, undergoing fetoscopic tracheal occlusion (FETO).

METHOD:
Retrospective, descriptive study, approved by the Institutional Ethics Committee. Data were obtained from medical and anesthetic records.

RESULTS:
FETO was performed in 28 pregnant women. Demographic characteristics: age 29.8±6.5; weight 68.64±12.26; ASA I and II. Obstetric: IG 26.1±1.10 weeks (in FETO); 32.86±1.58 (disocclusion); 34.96±2.78 (delivery). Delivery: cesarean section, vaginal delivery. Fetal data: Weight (g) in the occlusion and delivery times, respectively (1045.82±222.2 and 2294±553); RPC in FETO and disocclusion: 0.7±0.15 and 1.32±0.34, respectively. Preoperative maternal anesthesia included ranitidine and metoclopramide, nifedipine (VO) and indomethacin (rectal). Preanesthetic medication with midazolam IV. Anesthetic techniques: combination of 0.5% hyperbaric bupivacaine (5-10mg) and sufentanil; continuous epidural predominantly with 0.5% bupivacaine associated with sufentanil, fentanyl, or morphine; general. In 8 cases, there was need to complement via catheter, with 5 submitted to PC and 3 to BC. Thirteen patients required intraoperative sedation; ephedrine was used in 15 patients. Fetal Anesthesia: fentanyl 10 to 20mg/kg and pancuronium 0,1-0,2mg/kg (IM). Neonatal survival rate was 60.7%.

CONCLUSION:
FETO is a minimally invasive technique for severe congenital diaphragmatic hernia repair. Combined blockade associated with sedation and fetal anesthesia proved safe and effective for tracheal occlusion.

PMID: 27157206 [PubMed - as supplied by publisher]