Use of Anesthesia on the Fetus in an Open Fetal Surgery Might be Safe

Highlights

• Using anesthesia on the fetus in case of open fetal surgery may help reduce the risk of fetal mortality.
• Open fetal surgery (OFS) is critical surgery for both the mother and fetus. It is generally performed to save the lives of babies with various diagnoses before they are born.
• Anesthesia given directly to the fetus might be beneficial as it may help reduce fetal stress and thereby decrease the chances of fetal mortality.

In second trimester of pregnancy, it has been observed that the baby starts experiencing pain, in response to harmful stimulus and so in case of emergencies or a planned open fetal surgery, the fetus should also be given anesthesia. Using anesthesia for such procedures could decrease the risk of fetus mortality. The findings of this study are published in the journal of Child’s Nervous System.

It has been popularly believed that in the case of fetal interventions, it is enough to give anesthesia just to the mother, as they believe that the drugs will pass through the fetus through the umbilical cord.

Now the experts suggest that this might not be true, as the baby after 21 weeks become aware of the pain and so they think it needs to be anesthetized too.

"At the Hospital Virgen del Roc, we have spent a decade doing open fetal surgery. In 2007, we did the first intrauterine spina bifida operation in Europe, and in only one case was the fetus unable to receive intravenously administered anesthesia from the start of the operation. It was at that moment that our monitoring teams detected anomalies in the behavior of the fetus, which led us to believe that this was effectively a reaction to the stress caused by the pain. We quickly out in place the anesthesia protocol and the spinal reconstruction was possible and the post-op period passed without any problems", explains Doctor Javier Márquez Rivas, Heat of the Infant Neurosurgery Unit and the Neurosurgery Service at the hospital.

Dr. María J. Mayorga Buiza, a pediatric anesthetist, believes that during open fetal surgery, it is very important to help uterus relax, keep fetal circulation stable and offer adequate management of the patient to avoid contractions after the surgery.

Open fetal surgery (OFS) is critical surgery for mother and the fetus, and so in such cases, anesthesia given directly to the fetus might be beneficial as it may help reduce fetal stress and the incidence of fetal mortality.

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Even though the perception of fetal pain before the third trimester is not proven, it is a confirmed fact that fetal mortality is higher than 20% in the case of non-anesthetised fetuses.

This rate of fetal mortality dropped to 0% in operations carried out until now at the University Hospital Virgen del Rocío in Seville.

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"The response of fetal stress to harmful stimulation that our monitoring teams observed in this case does not completely prove that the fetus can feel pain. However, it is very improbable that there can be a perception of pain without a response to stress, and so these signals are often used as a substitute pain indicator", explains the University of Seville researcher and co-author of this study, The Applied Physics professor Emilio Gómez González.

"To advance in the area of anesthesia is to advance in surgery. Formerly, there were patients who died from pain, therefore, the better our knowledge and training in anesthesia and the greater the abilities of the monitoring teams, the more complex surgery can be", states Doctor Mayorga Buiza.

Source-Eurekalert