Maternal anaesthesia in open and fetoscopic surgery of foetal open spinal neural tube defects

Manrique, Susana; Maíz, Nerea; García, Irene; Pascual, Montserrat Hernández; Perera, Remei; Arévalo, Sílvia; Giné, C; Molino, Jose Andrés; López, María Cristina Lorente; Blanco, D; Nadal, Miriam de; Carreras, Elena

doi:10.1097/eja.0000000000000930

Cited by 17 publications

(19 citation statements)

References 21 publications

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“…Minimally invasive approaches to repair fetal MMC have been implemented in different centers [7][8][9][10][11][12][13][14][15][16][17][18] to decrease obstetric and perinatal morbidity, while preserving the improved infant outcomes. In our experience, the main advantages of the exteriorized-uterus two-port fetoscopic approach 7 , used in our center, are the decreased incidence of maternal complications, the possibility of vaginal delivery 19 and a higher gestational age (GA) at birth than that seen when using the open-hysterotomy approach.…”

Section: Introductionmentioning

confidence: 99%

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy‐assisted fetoscopic or open approach

Sanz‐Cortes

Torres

Yepez

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? Prenatal and postnatal brain microstructure is similar between infants who underwent open hysterotomy and those who had fetoscopic spina bifida repair, and changes seen over time were also comparable between the two groups. These findings support the safety of using CO 2 gas for uterine insufflation during fetoscopic spina bifida repair. What are the clinical implications of this work?The findings of this study add to the body of evidence supporting the use of CO 2 for uterine insufflation in fetoscopic myelomeningocele repair. Fetoscopic techniques are safer for the mother and the fetus than is open repair. As a shift in practice towards fetoscopic repair is expected, evidence for the safety of CO 2 use is of critical relevance. ABSTRACTObjective To compare prenatal and postnatal brain microstructure between infants that underwent fetoscopic myelomeningocele (MMC) repair and those that had open-hysterotomy repair. Methods This was a longitudinal retrospective cohort study of 57 fetuses that met the Management of Myelomeningocele Study (MOMS) trial criteria and underwent prenatal MMC repair, by a fetoscopic (n = 27) or open-hysterotomy (n = 30) approach, atResults There were no differences in GA at surgery or GA/postnatal age at MRI between the groups. No significant differences were observed in ADC values in any of the brain areas assessed between the open-repair and fetoscopic-repair groups at 6 weeks after surgery and in the first year after birth. No differences were detected in the ADC values of the studied areas between the control 88 Sanz Cortes et al. and prenatally repaired groups, except for significantly increased ADC values in the genu of the corpus callosum in the open-hysterotomy and fetoscopic-repair groups. Additionally, there were no differences between the two prenatally repaired groups in the percentage change in ADC values at any of the time intervals analyzed. ConclusionsFetoscopic MMC repair has no detectable effect on brain microstructure when compared to babies repaired using an open-hysterotomy technique. CO 2 insufflation of the uterine cavity during fetoscopy does not seem to have any isolated deleterious effects on fetal brain microstructure.

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Section: Introductionmentioning

confidence: 99%

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy‐assisted fetoscopic or open approach

Sanz‐Cortes

Torres

Yepez

et al. 2020

Ultrasound in Obstet & Gyne

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“…Appropriate anesthesia protocol is paramount to the success of open and fetoscopic repair of MMC in utero. Data from a retrospective cohort study comparing anesthesia protocol in open with fetoscopic MMC repair found that open surgery was associated with higher doses of halogenated anesthetic agents, sevoflurane, increased need for intra-operative tocolytic drugs with nitroglycerine, and postoperative tocolysis with magnesium sulfate, and a higher volume of colloids 183. From a hemodynamic standpoint, median mean arterial pressure was lower in open versus fetoscopic surgery; systolic blood pressure, diastolic blood pressure, and mean blood pressure decreased during uterine exposure, and this descent was more acute in open surgery 183.…”

Section: Fetal Endoscopic Surgeriesmentioning

confidence: 99%

Prenatal regenerative fetoscopic interventions for congenital anomalies

Ruano

2020

BMJ

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Abstract Fetal intervention has progressed in the past two decades from experimental proof-of-concept to practice-adopted, life saving interventions in human fetuses with congenital anomalies. This progress is informed by advances in innovative research, prenatal diagnosis, and fetal surgical techniques. Invasive open hysterotomy, associated with notable maternal-fetal risks, is steadily replaced by less invasive fetoscopic alternatives. A better understanding of the natural history and pathophysiology of congenital diseases has advanced the prenatal regenerative paradigm. By altering the natural course of disease through regrowth or redevelopment of malformed fetal organs, prenatal regenerative medicine has transformed maternal-fetal care. This review discusses the uses of regenerative medicine in the prenatal diagnosis and management of three congenital diseases: congenital diaphragmatic hernia, lower urinary tract obstruction, and spina bifida.

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“…Notably, the Type A GABA (GABAA) receptor, the main target of sevoflurane, is excitatory rather than inhibitory in the immature neurons [ 44 ]. Interestingly, the new field of antenatal corrective surgery requires particularly high concentrations of sevoflurane to relax the uterus over many hours, exposing an undeveloped fetus to unprecedented quantities of GA [ 45 ]. That said, any pregnancy GA exposure generally will reach the embryo or fetus, exposing the developing germline, an important concern since early stage germ cells possess heightened vulnerabilities to toxicants [ 30 ].…”

Section: Ga and Svags In Historical And Clinical Contextmentioning

confidence: 99%

General anesthesia, germ cells and the missing heritability of autism: an urgent need for research

Escher¹,

Ford²

2020

Environmental Epigenetics

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Agents of general anesthesia (GA) are commonly employed in surgical, dental and diagnostic procedures to effectuate global suppression of the nervous system, but in addition to somatic targets, the subject’s germ cells—from the embryonic primordial stage to the mature gametes—may likewise be exposed. Although GA is generally considered safe for most patients, evidence has accumulated that various compounds, in particular the synthetic volatile anesthetic gases (SVAGs) such as sevoflurane, can exert neurotoxic, genotoxic and epigenotoxic effects, with adverse consequences for cellular and genomic function in both somatic and germline cells. The purpose of this paper is to review the evidence demonstrating that GA, and in particular, SVAGs, may in some circumstances adversely impact the molecular program of germ cells, resulting in brain and behavioral pathology in the progeny born of the exposed cells. Further, we exhort the medical and scientific communities to undertake comprehensive experimental and epidemiological research programs to address this critical gap in risk assessment.

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Maternal anaesthesia in open and fetoscopic surgery of foetal open spinal neural tube defects

Cited by 17 publications

References 21 publications

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy‐assisted fetoscopic or open approach

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy‐assisted fetoscopic or open approach

Prenatal regenerative fetoscopic interventions for congenital anomalies

General anesthesia, germ cells and the missing heritability of autism: an urgent need for research

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