Anesthetic management of abdominal radical trachelectomy for uterine cervical cancer during pregnancy

Abdominal radical trachelectomy has been identified as a surgical option for fertility preservation in cervical cancer patients, particularly in pregnant women who strongly desire to continue their pregnancy. Since this procedure requires operating in the uterus, the hardness of the uterus can affec...

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Bibliographic Details
Published in:Journal of anesthesia 2017-06, Vol.31 (3), p.467-471
Main Authors: Terukina, Jun, Takamatsu, Misako, Enomoto, Takayuki, Baba, Hiroshi
Format: Article
Language:English
Subjects:
Abdomen
Adult
Anesthesia
Anesthesiology
Anesthetics - administration & dosage
Central nervous system agents
Cervical cancer
Clinical Report
Critical Care Medicine
Emergency Medicine
Female
Fetal development
Gynecologic Surgical Procedures - methods
Heart rate
Humans
Intensive
Medicine
Medicine & Public Health
Pain Medicine
Pregnancy
Pregnancy Complications, Neoplastic - surgery
Pregnant women
Propofol
Surgery
Trachelectomy - methods
Uterine Cervical Neoplasms - surgery
Women's health
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Summary:Abdominal radical trachelectomy has been identified as a surgical option for fertility preservation in cervical cancer patients, particularly in pregnant women who strongly desire to continue their pregnancy. Since this procedure requires operating in the uterus, the hardness of the uterus can affect the ease of surgery. Generally, sevoflurane is used for anesthesia in non-obstetric surgery for pregnant women because uterine relaxation is advantageous for uterine blood flow maintenance. However, the use of sevoflurane during radical trachelectomy has not been thoroughly evaluated. Here, we report on anesthesia use in three cases of abdominal radical trachelectomy during pregnancy. Propofol enabled maintenance of uterine tension while not significantly affecting fetal growth. It is important to consider maintenance of uterine tension and fetal circulation in anesthesia management. During the operation, we performed an ultrasound examination every 30 min to confirm fetal well-being. Although frequent fetal heart rate monitoring of the pre-viable fetus is not recommended, if fetal bradycardia is detected, sevoflurane may then be used to improve fetal circulation. Additionally, if the fetal heartbeat stops, a radical hysterectomy would then be required. Therefore, we consider that fetal heart rate monitoring during this procedure is necessary, and propofol is suitable as an anesthetic for this surgery during pregnancy.
ISSN:0913-8668
1438-8359
DOI:10.1007/s00540-017-2325-3