Anesthesia for fetal surgery
Section snippets
Maternal anesthetic considerations
In contrast to nonsurgical therapy of the fetus or midgestation nonobstetric surgery, fetal surgery involves the simultaneous treatment of 2 patients. It is therefore incumbent on the anesthesiologist to monitor and treat both the fetus and the mother. The physiology of the parturient contributes to increased anesthetic risk for both the mother and fetus.
Unlike obstetric anesthetic practice, general anesthesia is the technique of choice for open fetal surgery. The major organ systems
Fetal anesthetic considerations
Fetal diseases amenable to surgical correction often compromise or disturb cardiovascular function. The combination of immature organ function and cardiovascular disease predispose the fetus to anesthetic-related difficulty.
Maintenance of fetal cardiovascular stability is the primary concern of anesthetic management. The fetal cardiovascular system is less able to compensate for hypoxia and hypovolemia than a full-term infant. Lacking a functional pulmonary system to increase oxygen tension,
Utero-placental anesthetic consideration
Fetal survival depends on transfer of oxygen from the mother to the fetus. Uterine and umbilical artery blood flow and placental barriers to diffusion influence fetal oxygenation. Maternal systemic blood pressure and myometrial tone affect uterine artery blood flow. Volatile anesthetics decrease myometrial tone and also tend to decrease both maternal blood pressure and placental blood flow. This can result in a decrease in fetal oxygenation.19, 20, 21 Thus, maintenance of maternal arterial
Open fetal surgery
Open fetal surgeries usually are performed on the midgestation fetus with myelomeningocele, congenital cystic adenomatoid malformation, or sacrococcygeal teratoma. To qualify as a surgical candidate, a mother must undergo extensive medical and psychosocial screening, have a fetus with disease that merits intervention, and be at low maternal risk for anesthesia and surgery. This surgery is contraindicated for mothers with serious medical diseases or fetuses with other disabling/lethal congenital
Conclusion
Anesthesia for fetal surgery is an evolving field. The anesthetic techniques that have emerged are safe for mother and fetus. Because of the myriad of anesthetic and surgical issues these cases generate, it is essential to have good communication and cooperation between surgeons and anesthesiologists from the preoperative period to the postoperative period. This will allow development of a cohesive anesthetic and surgical plan that can be used for the safe perioperative management of the fetal
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Anesthesia for fetal surgery
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Fetoscopic tracheal occlusion for severe congenital diaphragmatic hernia: retrospective study
2017, Brazilian Journal of AnesthesiologyHistory of Pediatric Anesthesia
2016, Smith's Anesthesia for Infants and Children, Ninth EditionMaternal and fetal safety of fluid-restrictive general anesthesia for endoscopic fetal surgery in monochorionic twin gestations
2014, Journal of Clinical AnesthesiaCitation Excerpt :These case reports notwithstanding, pulmonary edema appears to be much less common after minimally invasive fetal surgery, and severe IV fluid restriction is no longer routine [9]. Today, most cases of endoscopic laser surgery for TTTS are performed using epidural anesthesia or conscious sedation [7,24,25], but general anesthesia remains a useful alternative, particularly in difficult cases [7,12,15]. General anesthesia has several advantages that may favor its use in this patient population.
Intrauterine myelomeningocele repair: Experience of the fetal medicine and therapy program of the Virgen de Rocío University Hospital
2013, Revista Espanola de Anestesiologia y ReanimacionHistory of Pediatric Anesthesia
2011, Smith's Anesthesia for Infants and Children: Expert Consult Premium Edition - Enhanced Online Features and Print