BJA Advance Access originally published online on February 24, 2009
British Journal of Anaesthesia 2009 102(4):523-527; doi:10.1093/bja/aep016
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Maternal haemodynamics and lung water content during percutaneous fetoscopic interventions under general anaesthesia
1 Department of Anaesthesiology and Intensive Care Medicine
2 Department of Obstetrics and Prenatal Medicine, German Centre for Fetal Surgery and Minimally-Invasive Therapy, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
* Corresponding author: Department of Anaesthesiology and Intensive Care Medicine, Kreiskrankenhaus Mechernich GmbH, St Elisabeth Str. 2-6, D-53894 Mechernich, Germany. E-mail: rudolf.hering{at}ukb.uni-bonn.de
Background: The purpose of our study was to evaluate the maternal cardiopulmonary function and lung water content during percutaneous fetoscopic interventions under general maternal–fetal anaesthesia and continuous tocolytic medication.
Methods: We prospectively studied 13 women between 19 and 30 weeks of gestation undergoing percutaneous fetoscopic procedures that were performed under general maternal–fetal anaesthesia and tocolysis using indomethacin. Invasive haemodynamic monitoring using pulmonary artery catheters and the transpulmonary indicator dilution technique was applied to determine intrathoracic blood volume (ITBV), cardiac output, and extravascular lung water (EVLW). Pulmonary vascular permeability was estimated as the ratio of EVLW/ITBV. Measurements were performed during and for 24 h after the interventions.
Results: Respective mean (SD) maternal ITBV and cardiac output were 894 (191) ml min–1 m–2 and 3.29 (0.51) litre–1 min–1 m–2 intraoperatively, and 843 (169) ml min–1 m–2 and 4.47 (0.55) litre min–1 m–2 during the first postoperative day. EVLW was 7.9 (2.7) ml kg–1 during the interventions and 7.7 (1.8) ml kg–1 during the first postoperative day. The pulmonary vascular permeability index was calculated as 0.35 (0.06) during the interventions and 0.38 (0.14) for the first postoperative day. Clinically overt pulmonary oedema was not detected in any woman while pulmonary gas exchange remained normal.
Conclusions: In mid-gestational women undergoing percutaneous fetoscopic interventions under general maternal–fetal anaesthesia, cardiopulmonary function remained stable. However, a moderate increase in EVLW and pulmonary vascular permeability indicates an increased risk for maternal pulmonary oedema.
Keywords: anaesthesia, obstetric; complications, pulmonary oedema; fetus; heart, cardiac output; monitoring, cardiopulmonary