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

• 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
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-017-2325-3

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.