Anesthesia for In Utero Repair of Myelomeningocele
* Assistant Professor, Department of Anesthesia and Perioperative Care, † Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, ‡ Professor, Department of Surgery, Division of Pediatric Surgery, § Associate Professor, Departments of Anesthesia and Perioperative Care and Surgery, University of California San Francisco, San Francisco, California.Anesthesiology (Impact Factor: 5.88). 03/2013; 118(5). DOI: 10.1097/ALN.0b013e31828ea597
Recently published results suggest that prenatal repair of fetal myelomeningocele is a potentially preferable alternative when compared to postnatal repair. In this article, the pathology of myelomeningocele, unique physiologic considerations, perioperative anesthetic management, and ethical considerations of open fetal surgery for prenatal myelomeningocele repair are discussed. Open fetal surgeries have many unique anesthetic issues such as inducing profound uterine relaxation, vigilance for maternal or fetal blood loss, fetal monitoring, and possible fetal resuscitation. Postoperative management, including the requirement for postoperative tocolysis and maternal analgesia, are also reviewed. The success of intrauterine myelomeningocele repair relies on a well-coordinated multidisciplinary approach. Fetal surgery is an important topic for anesthesiologists to understand, as the number of fetal procedures is likely to increase as new fetal treatment centers are opened across the United States.
- Anesthesiology 03/2013; 118(5). DOI:10.1097/ALN.0b013e31828ea497 · 5.88 Impact Factor
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ABSTRACT: Gastroschisis requires surgical repair, which is generally performed after birth. We report a case in which a fetus with gastroschisis underwent the abdominal wall defect repair before birth. To ensure reliable operating conditions for the repair (to prevent fetal movement and crying), the fetus received deep anesthesia via placental transfer of maternally administered anesthetics. Meanwhile, the ex utero intrapartum treatment procedure was performed to ensure fetal oxygen supply, which was likely to be compromised by the deep fetal anesthesia. The procedure last for 23 minutes and the gastroschisis was successfully repaired before the neonate was delivered. Maternal hemodynamics was kept stable during this surgical procedure. The prenatal repair of abdominal wall defect is safe for the mother and the fetus, which could potentially improve the neonatal outcomes.International Journal of Clinical and Experimental Medicine 05/2015; 8(5):8234-7. · 1.28 Impact Factor
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