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Research: Fetal anesthesia: intrauterine therapies and immediate postnatal anesthesia for noncardiac surgical interventions.

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Research: Fetal anesthesia: intrauterine therapies and immediate postnatal anesthesia for noncardiac surgical interventions.

Curr Opin Anaesthesiol. 2020 Apr 18. doi: 10.1097/ACO.0000000000000862. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/32324666

Fetal anesthesia: intrauterine therapies and immediate postnatal anesthesia for noncardiac surgical interventions.

Nelson O1Simpao AF1,2Tran KM1,2Lin EE1,2.

Author information

Abstract

PURPOSE OF REVIEW:

This review describes maternal and fetal anesthetic management for noncardiac fetal surgical procedures, including the management of lower urinary tract obstruction, congenital diaphragmatic hernia (CDH), myelomeningocele, sacrococcygeal teratoma, prenatally anticipated difficult airway and congenital lung lesions.

RECENT FINDINGS:

Fetal interventions range from minimally invasive fetoscopic procedures to mid-gestation open surgery, to ex-utero intrapartum treatment procedure. Anesthetic management depends on the fetal intervention and patient characteristics. Anesthesia for most minimally invasive procedures can consist of intravenous sedation and local anesthetic infiltration in clinically appropriate maternal patients. Open fetal and ex-utero intrapartum treatment procedures require maternal general anesthesia with volatile anesthetic and other medications to maintain uterine relaxation. Tracheal balloons are a promising therapy for CDH and can be inserted via minimally invasive techniques. Management of the prenatally anticipated difficult airway during delivery and removal of tracheal balloons from patients with CDH during delivery can be clinically dynamic and require flexibility, seamless communication and a high-functioning, multidisciplinary care team.

SUMMARY:

Maternal and fetal anesthetic management is tailored to the fetal intervention and the underlying health of the fetus and mother.PMID: 32324666 DOI: 10.1097/ACO.0000000000000862

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