Secrets of anesthesia in fetoscopic surgery

Abstract

Certain life-threatening congenital malformations have the opportunity to be treated with minimally invasive fetal surgery. In recent years fetoscopic surgery had a triggered interest. During the fetoscopic surgery all interventions effecting uteroplasental blood flow and eventually fetal oxygenation, may occur as complications like cardiac depression, maternal hypotension or pulmonary edema. Liaise with the increase in cardiac output and heart rate, the pregnant patient may display increased sensitivity to muscle relaxants and inhalational anesthetics. Due to incomplete myelination and synaptic activation, the fetus becomes more sensitive to volatile agents and analgesics. A goal directed therapy is necessary for both maternal and fetal well-being. According to goal directed therapy, perioperative fluid, vasopressor and inotropic agent titration is recommended to be used taking into account the systemic and pulmonary vascular hemodynamics of patients as well as the pulmonary vascular permeability and fluid content. Perioperative anesthesia management with hemodynamic monitorization, airway management and postoperative pain therapy are key features that make up the secrets of anesthesia. The patient's postoperative suffering from pain also leads to fetal and maternal stress by causing uterine contractions. Thus, appropriate treatment of postoperative pain should be provided using intravenous or epidural patient-controlled analgesia. One of the most important issues in the postoperative period is to prevent patient's premature contraction and not to trigger a premature birth. (C) 2015 Elsevier Ltd. All rights reserved.