An overview of foetal surgical procedures and the anaesthetic techniques used. Discussion about the need for foetal analgesia.

1. Anaesthesia for foetal surgery Dr. F. De Buck Anaesthesiology University Clinics Leuven Belgium. 11 feb 2011

2. Indications for foetal surgery Deprest et al. Sem Fetal Neonatal Med 2006; 11, 398 - 412.

6. EXIT procedure

9. Fetoscopic Endoluminal Tracheal Occlusion Deprest et al. Sem Fetal Neonatal Med 2006; 11, 398 - 412.

11. Isolated congenital diaphragmatic hernia Deprest et al. Sem Fetal Neonatal Med 2006; 11, 398 - 412.

14. Laser ablation for TTTS Deprest et al. Sem Fetal Neonatal Med 2006; 11, 398 - 412.

15. Laser ablation for TTTS Deprest et al. Sem Fetal Neonatal Med 2006; 11, 398 - 412.

18. Foetal anaesthesia Does the foetus feel pain ? Responses to noxious stimuli

21. foetus or neonate ? Both have the same gestational age !

23. Anatomical pathways 0: Peripheral receptors 1: Afferent fibres 2: Spino-thalamic fibres 3: Thalamus 4,5: Thalamo-cortical fibres 6: Inhibitory efferent fibres Lowery et al. Sem Perinatol 2007; 31, 275.

28. Cortisol levels IHV PCI Giannakoulopoulos et al. The Lancet 1994; 344, 77-81.

29. Noradrenalin Giannakoulopoulos et al. Ped Res 1999; 45, 494 - 499.

32. Long term implications Taddio et al. The Lancet 1997; 349, 599 - 603. Hyperalgesia after circumcision

35. Pain stimulus in utero De Buck et al. IJOA 2009; S1.

36. foetal pain perception Does the foetus feel pain ? Foetal analgesia ?

37. Foetal opioids Fisk et al. Anesthesiology 2001; 95, 828 – 835.

38. Fentanyl decreases foetal stress response Fisk et al. Anesthesiology 2001; 95, 828 – 835.

41. Without sedation...

45. Thank you