Anesthesia for fetal surgery
Keywords:
Anesthesia, Fetus, Pain, Pregnancy
Abstract
Introduction: Fetal surgery is making huge strides in medicine due to the breakthroughs in prenatal medicine that have opened a window into early diagnosis of abnormalities which may be subject to prenatal interventions. Fetal interventional procedures range from minimally invasive surgery on the fetus, the placenta or membranes, to open techniques requiring laparotomy and maternal hysterectomy
Objective: A narrative review of anesthetic techniques used in fetal surgery. For that purpose, a non-systematic review of medical databases publications including MEDLINE, SciELO and EMBASE, was undertaken usingthe terms "anesthesia and fetal surgery" and restricted to the following types of publications: "Practice Guideline, Randomized Controlled Trial, Review".
Results:Minimally invasive procedures may be performed under local anesthesia or neuraxial techniques, with appropriate sedation of the mother, analgesia/anesthesia and fetal immobilization. The development of anesthetic techniques in this area should focus on minimizing maternal risk and preserving a normal neural development of the fetus.
References
1. De Buck F, Deprest J, Van de Velde M. Anesthesia for fetal surgery. Curr Opin Anaesthesiol. 2008;21:293-7.
2. Deprest JA, Done E, Van Mieghem T, Gucciardo L. Fetal surgery for anesthesiologists. Curr Opin Anaesthesiol. 2008;21:298-307.
3. Tran K. Anesthesia for fetal surgery. Semin Fetal Neonat Med. 2010;15:40-5.
4. Goodman S. Anesthesia for nonobstetric surgery in the pregnant patient. Semin Perinatol. 2002;26:136-45.
5. Valman HB, Pearson JF. What the fetus feels. Br Med J. 1980;280:233-4.
6. Anand KJ, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med. 1987;317:1321-9.
7. Glover V, Fisk NM. Fetal pain: implications for research and practice. Br J Obstet Gynaecol. 1999;106:881-6.
8. Giannakoulopoulos X, Sepülveda W, Kourtis P, Glover V, Fisk NM. Fetal plasma cortisol and betaendorphin response to intrauterine needling. Lancet. 1994;344:77-81.
9. Gitau R, Fisk NM, Glover V. Human fetal and maternal corticotrophin releasing hormone responses to acute stress. Arch Dis Child Fetal Neonatal Ed. 2004;89:F29-32.
10. Fisk NM, Gitau R, Teixeira JM, Giannakoulopoulos X, Cameron AD, Glover VA. Effect of direct fetal opioid analgesia on fetal hormonal and hemodynamic stress response to intrauterine needling. Anesthesiology. 2001;95:828-35.
11. Teixeira JM, Glover V, Fisk NM. Acute cerebral redistribution in response to invasive procedures in the human fetus. Am J Obstet Gynecol. 1999;181:1018-25.
12. Van de Velde M, De Buck F, Van Mieghem T, Gucciardo L, Deprest JA. Fetal anaesthesia: is this necessary for fetoscopic therapy? Fetal Maternal Med Rev. 2010;21:124-35.
13. Anand KJS, Soriano SG. Anesthetic agents and the immature brain: are these toxic or therapeutic agents? Anesthesiology. 2004;101:527-30.
14. Kuan CY, Roth KA, Flavell RA, Rakic P. Mechanisms of programmed cell death in the developing brain. Trends Neurosci. 2000;23:291-7.
15. Creeley C. The young: neuroapoptosis induced by anesthetics and what to do about it. Anesth Analg. 2010;110:442-8.
16. Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23:876-82.
17. Anand KJ, Coskun V, Thrivikraman KV, Nemeroff CB, Plotsky PM. Long-term behavioral effects of repetitive pain in neonatal rat pups. Physiol Behav. 1999;66:627-37.
18. Stratmann G. Neurotoxicity of anesthetic drugs in the developing brain. Anesth Analg. 2011;113:1170-9.
19. Jevtovic-Todorovic V. Anesthesia and the developing brain: are we getting closer to understanding the truth. Curr Opin Anaesthesiol. 2011;24:395-9.
20. Hudson AE, Hemmings Jr HC. Are anaesthetics toxic to the brain. Br J Anaesth. 2011;107:30-7.
21. Sun LS. Labor analgesia and the developing human brain. Anesth Analg. 2011;112:1265-7.
22. Flick RP, Lee K, Hofer RE, Beinborn CW, Hambel EM, Klein MK, et al. Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities. Anesth Analg. 2011;112:1424-31.
23. Radcliffe J, Bellinger DC. Learning disability in children as an outcome in anesthesia and analgesia. Anesth Analg. 2011;112:1262-4.
24. Sprung J, Flick RP, Wilder RT, Katusic SK, Pike TL, Dingli M, et al. Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort. Anesthesiology. 2009;111:302-10.
25. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011;114:495-511.
26. Smith I, Kranke P, Murat I, Smith A, O'Sullivan G, S0reide E, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28:556-69.
27. Adzick NS, Thom EA, Spong CY, Brock 3rd JW, Burrows PK, Johnson MP, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 2011;364:993-1004.
28. Simpson JL, Greene MF. Fetal surgery for myelomeningocele?. N Engl J Med. 2011;364:1076-7.
29. Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004;351:136-44.
30. Myers LB, Cohen D, Galinkin J, Gaiser R, Kurth D. Anaesthesia for fetal surgery. Paediatr Anaesth. 2002;12:569-78.
31. Adzick N. Open fetal surgery for life-threatening fetal anomalies. Semin Fetal Neonat Med. 2010;15:1-8.
32. Adzick N. Fetal myelomeningocele: natural history, pathophysiology, and in-utero intervention. Semin Fetal Neonatal Med. 2010;15:9-14.
33. Hirose S. Fetal surgery for myelomeningocele. Clin Perinatol. 2009;36:431-8.
34. Adzick N. Management of fetal lung lesions. Clin Perinatol. 2009;36:363-76.
35. Liechty K. Ex-utero intrapartum therapy. Semin Fetal Neonat Med. 2010;15:34-9.
36. Hedrick MH, Ferro MM, Filly RA, Flake AW, Harrison MR, Adzick NS. Congenital high airway obstruction syndrome (CHAOS): a potential for perinatal intervention. J Pediatr Surg. 1994;29:271-4.
37. Kunisaki SM, Fauza DO, Barnewolt CE, Estroff JA, Myers LB, Bulich LA, et al. Ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation for fetal thoracic masses. J Pediatr Surg. 2007;42:420.
38. George RB, Melnick AH, Rose EC, Habib AS. Case series: combined spinal epidural anesthesia for Cesarean delivery and ex utero intrapartum treatment procedure. Can J Anesth. 2007;54:218-22.
39. Benonis JG, Habib AS. Ex utero intrapartum treatment procedure in a patient with arthrogryposis multiplex congenita, using continuous spinal anesthesia and intravenous nitroglycerin for uterine relaxation. Int J Obstet Anesth. 2008;17:53-6.
40. Abraham R, Sau A, Maxwell D. A review of the EXIT (Ex utero Intrapartum Treatment) procedure. J Obstet Gynaecol. 2010;30:1-5.
41. Turner C, Tworetzky W, Wilkins-Haug L, Jennings R. Cardiac anomalies in the fetus. Clin Perinatol. 2009;36:439-49.
42. McElhinney DB, Tworetzky W, Lock JE. Current status of fetal cardiac intervention. Circulation. 2010;121:1256-63.
43. Habli M, Lim F, Crombleholme T. Twin-to-Twin transfusion syndrome: a comprehensive update. Clin Perinatol. 2009;36:391-416.
44. Bebbington M. Twin-to-twin transfusion syndrome: current understanding of pathophysiology, in-utero therapy and impact for future development. Semin Fetal Neonat Med. 2010;15:15-20.
45. Hedrick H. Management of prenatally diagnosed congenital diaphragmatic hernia. Semin Fetal Neonat Med. 2010;15: 21-7.
46. Jani J, Nicolaides K, Gratacos E, Valencia CM, Deprest JA. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol. 2009;34:304-10.
47. Deprest J, Nicolaides K, Done' E, Lewi P, Barki G, Largen E, et al. Technical aspects of fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia. J Pediatr Surg. 2011;46:22-32.
48. Deprest JA, Nicolaides K, Gratacos E. Fetal surgery for congenital diaphragmatic hernia is back from never gone. Fetal Diagn Ther. 2011;29:6-17.
49. Dekoninck P, Gratacos E, Van Mieghem T, Richter J, Lewi P, Ancel AM, et al. Results of fetal endoscopic tracheal occlusion for congenital diaphragmatic herniaand the set up of the randomized controlled TOTAL trial. Early Hum Dev. 2011;87:619-24.
50. Missant C, Van Schoubroeck D, Deprest J, Devlieger R, Teunkens A, Van de Velde M. Remifentanil for foetal immobilisation and maternal sedation during endoscopic treatment of twin-to-twin transfusion syndrome: a preliminary dose-finding study. Acta Anaesth Belg. 2004;55:239-44.
51. Van de Velde M, Van Schoubroeck D, Lewi LE, Marcus MAE, Jani JC, Missant C, et al. Remifentanil for fetal immobilization and maternal sedation during fetoscopic surgery: a randomized, double blind comparison with diazepam. Anesth Analg. 2005;101:251-8.
2. Deprest JA, Done E, Van Mieghem T, Gucciardo L. Fetal surgery for anesthesiologists. Curr Opin Anaesthesiol. 2008;21:298-307.
3. Tran K. Anesthesia for fetal surgery. Semin Fetal Neonat Med. 2010;15:40-5.
4. Goodman S. Anesthesia for nonobstetric surgery in the pregnant patient. Semin Perinatol. 2002;26:136-45.
5. Valman HB, Pearson JF. What the fetus feels. Br Med J. 1980;280:233-4.
6. Anand KJ, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med. 1987;317:1321-9.
7. Glover V, Fisk NM. Fetal pain: implications for research and practice. Br J Obstet Gynaecol. 1999;106:881-6.
8. Giannakoulopoulos X, Sepülveda W, Kourtis P, Glover V, Fisk NM. Fetal plasma cortisol and betaendorphin response to intrauterine needling. Lancet. 1994;344:77-81.
9. Gitau R, Fisk NM, Glover V. Human fetal and maternal corticotrophin releasing hormone responses to acute stress. Arch Dis Child Fetal Neonatal Ed. 2004;89:F29-32.
10. Fisk NM, Gitau R, Teixeira JM, Giannakoulopoulos X, Cameron AD, Glover VA. Effect of direct fetal opioid analgesia on fetal hormonal and hemodynamic stress response to intrauterine needling. Anesthesiology. 2001;95:828-35.
11. Teixeira JM, Glover V, Fisk NM. Acute cerebral redistribution in response to invasive procedures in the human fetus. Am J Obstet Gynecol. 1999;181:1018-25.
12. Van de Velde M, De Buck F, Van Mieghem T, Gucciardo L, Deprest JA. Fetal anaesthesia: is this necessary for fetoscopic therapy? Fetal Maternal Med Rev. 2010;21:124-35.
13. Anand KJS, Soriano SG. Anesthetic agents and the immature brain: are these toxic or therapeutic agents? Anesthesiology. 2004;101:527-30.
14. Kuan CY, Roth KA, Flavell RA, Rakic P. Mechanisms of programmed cell death in the developing brain. Trends Neurosci. 2000;23:291-7.
15. Creeley C. The young: neuroapoptosis induced by anesthetics and what to do about it. Anesth Analg. 2010;110:442-8.
16. Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23:876-82.
17. Anand KJ, Coskun V, Thrivikraman KV, Nemeroff CB, Plotsky PM. Long-term behavioral effects of repetitive pain in neonatal rat pups. Physiol Behav. 1999;66:627-37.
18. Stratmann G. Neurotoxicity of anesthetic drugs in the developing brain. Anesth Analg. 2011;113:1170-9.
19. Jevtovic-Todorovic V. Anesthesia and the developing brain: are we getting closer to understanding the truth. Curr Opin Anaesthesiol. 2011;24:395-9.
20. Hudson AE, Hemmings Jr HC. Are anaesthetics toxic to the brain. Br J Anaesth. 2011;107:30-7.
21. Sun LS. Labor analgesia and the developing human brain. Anesth Analg. 2011;112:1265-7.
22. Flick RP, Lee K, Hofer RE, Beinborn CW, Hambel EM, Klein MK, et al. Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities. Anesth Analg. 2011;112:1424-31.
23. Radcliffe J, Bellinger DC. Learning disability in children as an outcome in anesthesia and analgesia. Anesth Analg. 2011;112:1262-4.
24. Sprung J, Flick RP, Wilder RT, Katusic SK, Pike TL, Dingli M, et al. Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort. Anesthesiology. 2009;111:302-10.
25. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011;114:495-511.
26. Smith I, Kranke P, Murat I, Smith A, O'Sullivan G, S0reide E, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28:556-69.
27. Adzick NS, Thom EA, Spong CY, Brock 3rd JW, Burrows PK, Johnson MP, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 2011;364:993-1004.
28. Simpson JL, Greene MF. Fetal surgery for myelomeningocele?. N Engl J Med. 2011;364:1076-7.
29. Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004;351:136-44.
30. Myers LB, Cohen D, Galinkin J, Gaiser R, Kurth D. Anaesthesia for fetal surgery. Paediatr Anaesth. 2002;12:569-78.
31. Adzick N. Open fetal surgery for life-threatening fetal anomalies. Semin Fetal Neonat Med. 2010;15:1-8.
32. Adzick N. Fetal myelomeningocele: natural history, pathophysiology, and in-utero intervention. Semin Fetal Neonatal Med. 2010;15:9-14.
33. Hirose S. Fetal surgery for myelomeningocele. Clin Perinatol. 2009;36:431-8.
34. Adzick N. Management of fetal lung lesions. Clin Perinatol. 2009;36:363-76.
35. Liechty K. Ex-utero intrapartum therapy. Semin Fetal Neonat Med. 2010;15:34-9.
36. Hedrick MH, Ferro MM, Filly RA, Flake AW, Harrison MR, Adzick NS. Congenital high airway obstruction syndrome (CHAOS): a potential for perinatal intervention. J Pediatr Surg. 1994;29:271-4.
37. Kunisaki SM, Fauza DO, Barnewolt CE, Estroff JA, Myers LB, Bulich LA, et al. Ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation for fetal thoracic masses. J Pediatr Surg. 2007;42:420.
38. George RB, Melnick AH, Rose EC, Habib AS. Case series: combined spinal epidural anesthesia for Cesarean delivery and ex utero intrapartum treatment procedure. Can J Anesth. 2007;54:218-22.
39. Benonis JG, Habib AS. Ex utero intrapartum treatment procedure in a patient with arthrogryposis multiplex congenita, using continuous spinal anesthesia and intravenous nitroglycerin for uterine relaxation. Int J Obstet Anesth. 2008;17:53-6.
40. Abraham R, Sau A, Maxwell D. A review of the EXIT (Ex utero Intrapartum Treatment) procedure. J Obstet Gynaecol. 2010;30:1-5.
41. Turner C, Tworetzky W, Wilkins-Haug L, Jennings R. Cardiac anomalies in the fetus. Clin Perinatol. 2009;36:439-49.
42. McElhinney DB, Tworetzky W, Lock JE. Current status of fetal cardiac intervention. Circulation. 2010;121:1256-63.
43. Habli M, Lim F, Crombleholme T. Twin-to-Twin transfusion syndrome: a comprehensive update. Clin Perinatol. 2009;36:391-416.
44. Bebbington M. Twin-to-twin transfusion syndrome: current understanding of pathophysiology, in-utero therapy and impact for future development. Semin Fetal Neonat Med. 2010;15:15-20.
45. Hedrick H. Management of prenatally diagnosed congenital diaphragmatic hernia. Semin Fetal Neonat Med. 2010;15: 21-7.
46. Jani J, Nicolaides K, Gratacos E, Valencia CM, Deprest JA. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol. 2009;34:304-10.
47. Deprest J, Nicolaides K, Done' E, Lewi P, Barki G, Largen E, et al. Technical aspects of fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia. J Pediatr Surg. 2011;46:22-32.
48. Deprest JA, Nicolaides K, Gratacos E. Fetal surgery for congenital diaphragmatic hernia is back from never gone. Fetal Diagn Ther. 2011;29:6-17.
49. Dekoninck P, Gratacos E, Van Mieghem T, Richter J, Lewi P, Ancel AM, et al. Results of fetal endoscopic tracheal occlusion for congenital diaphragmatic herniaand the set up of the randomized controlled TOTAL trial. Early Hum Dev. 2011;87:619-24.
50. Missant C, Van Schoubroeck D, Deprest J, Devlieger R, Teunkens A, Van de Velde M. Remifentanil for foetal immobilisation and maternal sedation during endoscopic treatment of twin-to-twin transfusion syndrome: a preliminary dose-finding study. Acta Anaesth Belg. 2004;55:239-44.
51. Van de Velde M, Van Schoubroeck D, Lewi LE, Marcus MAE, Jani JC, Missant C, et al. Remifentanil for fetal immobilization and maternal sedation during fetoscopic surgery: a randomized, double blind comparison with diazepam. Anesth Analg. 2005;101:251-8.
How to Cite
1.
Vasco Ramírez M. Anesthesia for fetal surgery. Colomb. J. Anesthesiol. [Internet]. 2012 Oct. 1 [cited 2024 Apr. 25];40(4):268–272. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/770
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2012-10-01
How to Cite
1.
Vasco Ramírez M. Anesthesia for fetal surgery. Colomb. J. Anesthesiol. [Internet]. 2012 Oct. 1 [cited 2024 Apr. 25];40(4):268–272. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/770
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Narrative review
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