Reactions 1449 - 27 Apr 2013

SDiazepam/fentanyl

Severe bradycardia and cardiac arrest following inutero exposure: 3 case reports

From a study, three fetuses [sexes not stated] were identifiedafter they developed cardiac arrest or severe bradycardiafollowing in utero exposure to diazepam and fentanyl [dosagesand durations of treatments to reaction onsets not stated]; twoof the fetuses subsequently died.

The first fetus, who had hydrops fetalis due to parvovirusinfection, underwent cordocentesis and blood transfusion at17 weeks’ gestation. The mother received IV diazepam and IVfentanyl for fetal anaesthesia. Thirty minutes after bloodtransfusion, the fetus developed cardiac arrest. The fetusreceived intracardiac epinephrine [adrenaline], glucose,insulin and pericardial blood drainage, and was resuscitated.At 27 weeks’ gestation, the fetus developed hydrops fetalisagain, and underwent repeat cordocentesis and bloodtransfusion with IV diazepam and IV fentanyl for fetalanaesthesia. Following blood transfusion, the fetus developedcardiac arrest. The fetus received intracardiac epinephrine;however, the fetus died.

The second fetus, who had hydrops fetalis andhaemophagocytic syndrome, underwent cordocentesis andblood transfusion at 31 weeks’ gestation. The mother receivedIV diazepam and IV fentanyl for fetal anaesthesia. Followingblood transfusion, the fetus developed cardiac arrest. The fetusreceived intracardiac epinephrine and underwent a caesareansection; however, the fetus died.

The third fetus, who had chylothorax and hydrops fetalis,underwent cordocentesis and thoracentesis at 34 weeks’gestation. The mother received IV diazepam and IV fentanyl forfetal anaesthesia. Following blood transfusion, the fetusdeveloped severe bradycardia. The fetus received intracardiacepinephrine and the mother received atropine. The fetus wasresuscitated, and was subsequently born alive and growingnormally.

Author comment: "We found that severe bradycardia orcardiac arrest occurred as fetal complications during directfetal procedures. It is unclear whether bradycardia was causedby the vagotonic effect of fentanyl, or myocardial depressanteffect of diazepam."Ohashi Y, et al. Success rate and challenges of fetal anesthesia for ultrasoundguided fetal intervention by maternal opioid and benzodiazepine administration.Journal of Maternal-Fetal and Neonatal Medicine 26: 158-160, No. 2, Jan 2013.Available from: URL: http://dx.doi.org/10.3109/14767058.2012.722733 -Japan 803085991

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Reactions 27 Apr 2013 No. 14490114-9954/10/1449-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved