title: [Fetoscopic tracheal occlusion for severe congenital diaphragmatic hernia: retrospective study].
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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 (reversal of occlusion); 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 reversal of occlusion: 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-1and pancuronium 0,1-0,2mg·kg-1(IM). Neonatal survival rate was 60.7%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil. Electronic address: franklinbraga@terra.com.br.
authors.forename: Angélica de Fátima de Assunção
authors.initials: AFA
authors.lastname: Braga
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Campinas, SP, Brasil.
authors.forename: Franklin Sarmento
authors.initials: FS
authors.lastname: da Silva Braga
authors.affiliation: Hospital de Base Dr. Ary Pinheiro, Porto Velho, RO, Brasil.
authors.forename: Solange Patricia
authors.initials: SP
authors.lastname: Nascimento
authors.affiliation: Hospital Vivalle, São José dos Campos, SP, Brasil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Verri
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Tocoginecologia, Campinas, SP, Brasil.
authors.forename: Fabio C
authors.initials: FC
authors.lastname: Peralta
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Tocoginecologia, Campinas, SP, Brasil.
authors.forename: João
authors.initials: J
authors.lastname: Bennini Junior
authors.affiliation: Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Tocoginecologia, Campinas, SP, Brasil.
authors.forename: Karina
authors.initials: K
authors.lastname: Jorge
mesh_terms: D000293:Adolescent; D000328:Adult; D000773:Anesthesia, Obstetrical; D005260:Female; D005332:Fetoscopy; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014132:Trachea; D055815:Young Adult
keywords: Anestesia; Anesthesia; Cirurgia fetal; Congenital diaphragmatic hernia; Diagnóstico pré‐natal; Fetal surgery; Fetoscopia; Fetoscopy; Hérnia diafragmática congênita; Oclusão traqueal; Prenatal diagnosis; Tracheal occlusion