Fetal and Maternal Analgesia/Anesthesia for Fetal Procedures

Abstract

For many prenatally diagnosed conditions, treatment is possible before birth. These fetal procedures can range from minimal invasive punctions to full open fetal surgery. Providing anesthesia for these procedures is a challenge, where care has to be taken for both mother and fetus. There are specific physiologic changes that occur with pregnancy that have an impact on the anesthetic management of the mother. When providing maternal anesthesia, there is also an impact on the fetus, with concerns for potential negative side effects of the anesthetic regimen used. The question whether the fetus is capable of feeling pain is difficult to answer, but there are indications that nociceptive stimuli have a physiologic reaction. This nociceptive stimulation of the fetus also has the potential for longer-term effects, so there is a need for fetal analgesic treatment. The extent to which a fetus is influenced by the maternal anesthesia depends on the type of anesthesia, with different needs for extra fetal anesthesia or analgesia. When providing fetal anesthesia, the potential negative consequences have to be balanced against the intended benefits of blocking the physiologic fetal responses to nociceptive stimulation.

Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

“…Considering the interdependence in the maternal-fetal circulation, hemodynamic stability often depends on the use of inotropes, vasopressors, and volumes in order to reverse maternal hypotension [10]. Anesthetic complications that cause deep maternal hypoxemia represent a potential risk to the fetus.…”

The effects of partial amniotic carbon dioxide insufflation in an ovine model

“…These insufflation pressures were chosen to reflect PACI pressures used clinically in fetoscopic MMC repair ranging from 9 to 30 mm Hg . A duration of 20 minutes at each insufflation pressure was used in an attempt to minimize any accumulating adverse physiological effects of prolonged general anesthesia . After desufflation, normal saline at body temperature was introduced to the uterine cavity to replace drained amniotic fluid.…”

“…7 A duration of 20 minutes at each insufflation pressure was used in an attempt to minimize any accumulating adverse physiological effects of prolonged general anesthesia. 18 After desufflation, normal saline at body temperature was introduced to the uterine cavity to replace drained amniotic fluid. Physiological recording as well as blood gas sampling continued for a further 20 minutes after desufflation.…”

Neonatal pain management among nurses and midwives at two Kigali hospitals

“…[7] There is still controversy concerning if and when a fetus experiences pain, though research findings now suggest a fetus may experience pain as early as at 20 weeks gestation. [8] Furthermore, the evidence shows that preterm neonates are more sensitive to pain due to a lower threshold and marked hyperinnervation in their central nervous systems. [3] As a result, preterm neonates with a prolonged NICU stay, experience the most exposure to painful stimuli, [3,6] which should be an essential nursing care consideration.…”