Dr. Alison KOO
Hong Kong

Dr Koo graduated from Guy’s King’s and St Thomas’ School of Medicine, University of London and is a member of the Royal College of Anaesthetists. After achieving the LMCHK (Licentiate Medical Council of Hong Kong) qualification, she returned to Hong Kong to join the Anaesthesia Department at The Prince of Wales Hospital where she is currently a Consultant and Director of Obstetric Anaesthesia services. She has collaborated extensively with the Obstetric team to implement practices to enhance maternal safety and improve maternal outcomes, and supports a commitment to strengthen maternal education and access to epidural labour analgesia. She is a regular lecturer at the School of Midwifery and for the MSc in Obstetric and Midwifery Care at The Chinese University of Hong Kong.

Anaesthesia for Fetal Surgery

Due to advances in prenatal imaging, genetic diagnosis, and refinement in surgical techniques, maternal-fetal-interventions have expanded in the last three decades. Fetal surgery offers the hope of complete prenatal cure, reduction of otherwise irreversible organ damage, and successful transition to extra-uterine life.

Providing anaesthesia for fetal surgery is a relatively new endeavour, but the anaesthetist plays a pivotal role within the multi-disciplinary fetal therapy team. The challenge lies in minimizing maternal and fetal risk whilst providing adequate operating conditions. Anaesthesia techniques have evolved over the years, but there is still lack of research to guide best practice.

As the unborn child is increasingly seen as a patient in its own right, the question of fetal neurodevelopmental outcome after exposure to anaesthesia is also of relevance, but remains difficult to answer. Whilst the complete avoidance of implicated anaesthetic agents may be impractical, it is incumbent upon us to exercise caution. As such, maternal general anaesthesia via supplementary intravenous techniques may be an effective but safer option, when compared with traditional techniques using high volatile concentrations. In addition, as evidence grows and supports the fetus’s capacity to react to painful stimuli from the second trimester onwards, it becomes the anaesthetist’s responsibility to provide appropriate analgesia to mitigate the harmful effects of stressors to fetal well-being.

Meticulous multi-disciplinary planning is essential to the successful outcome of any maternal-fetal-intervention. Both anaesthetist and surgeon, need to be well-rehearsed in managing fetal resuscitation.  This means there should be a pre-determined plan to manage fetal distress that includes the discussion of code status, especially when the fetus is at the early limits of viability.