International Journal of Obstetric Anesthesia

2019

DOI: 10.1016/j.ijoa.2018.08.009

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Multimodal general anesthesia approach for Ex Utero Intrapartum Therapy (EXIT) procedures: two case reports

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Cited by 4 publications

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“…Ninety-seven studies, accounting for 4,070 pregnancies, were included in the baseline characteristics and outcome analysis for MA ( 11 , 15 , 21 – 24 , 26 – 29 , 33 , 35 , 38 – 40 , 46 , 48 , 50 – 52 , 58 , 61 – 65 , 67 – 69 , 71 – 82 , 84 , 87 , 89 – 94 , 96 , 97 , 99 , 101 – 103 , 105 , 107 , 111 , 113 – 117 , 120 , 122 , 126 , 128 – 134 , 137 – 139 , 149 , 151 , 152 , 154 – 157 , 159 – 162 , 164 , 166 – 169 , 171 , 173 – 175 , 178 ). The aggregated mean GA at procedure, based on data from 85 studies (3,801 pregnancies), was 27.03 weeks ( 11 , 15 , 22 – 24 , 26 – 29 , 33 , 35 , 38 , 40 , …”

Section: Resultsmentioning

confidence: 99%

“…The aggregated mean GA at procedure, based on data from 85 studies (3,801 pregnancies), was 27.03 weeks ( 11 , 15 , 22 – 24 , 26 – 29 , 33 , 35 , 38 , 40 , 46 , 48 , 50 – 52 , 58 , 61 – 63 , 65 , 67 – 69 , 71 – 82 , 87 , 89 , 90 , 92 – 94 , 96 , 97 , 99 , 101 – 103 , 105 , 107 , 111 , 113 , 116 , 117 , 120 , 122 , 126 , 128 – 134 , 137 , 138 , 149 , 151 , 154 – 157 , 160 , 162 , 164 , 166 – 169 , 171 , 173 , 175 , 178 ). The mean LOH resulted to be 4.98 days, based on 24 studies involving 903 women ( 21 , 24 , 28 , 29 , 40 , 46 , 52 , 64 , 73 , …”

Section: Resultsmentioning

confidence: 99%

“…Ninety-five studies (3,905 pregnancies) were included for the comparative analysis of the anesthesia administration's routes ( 11 , 15 , 21 – 24 , 26 – 29 , 33 , 35 , 38 – 40 , 46 , 48 , 50 – 52 , 58 , 61 – 65 , 67 – 69 , 71 – 82 , 84 , 87 , 89 – 94 , 96 , 97 , 99 , 101 – 103 , 105 , 107 , 111 , 113 – 116 , 120 , 122 , 126 , 128 – 134 , 137 – 139 , 149 , 151 , 152 , 154 – 157 , 159 – 162 , 164 , 166 – 169 , 171 , 173 – 175 ). No statistically significant differences were found in the baseline characteristics and outcomes between patients receiving loco-regional and general anesthesia ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…MFA was provided in 1,551 procedures from 59 studies ( 12 , 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , 83 , 85 , 86 , 88 , 95 , 98 , 100 , 104 , 106 , 108 , 112 , 118 , 119 , 121 , 125 , 127 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 172 , 176 , 177 ). Fetal anesthesia administration was specified in 50 studies, consisting of 635 intramuscular injections (45 studies), 292 subcutaneous injections (three studies) and four intravenous injections (two studies) ( 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 , 44 , 47 , 49 , 50 , 52 , 54 , 55 ,…”

Section: Resultsmentioning

confidence: 99%

“…Fetal anesthesia administration was specified in 50 studies, consisting of 635 intramuscular injections (45 studies), 292 subcutaneous injections (three studies) and four intravenous injections (two studies) ( 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 , 44 , 47 , 49 , 50 , 52 , 54 , 55 , 57 , 59 , 63 , 83 , 86 , 95 , 98 , 100 , 104 , 106 , 108 , 118 , 119 , 121 , 125 , 127 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 176 , 177 ). An aggregate mean GA at procedure of 27.99 weeks was calculated on 49 studies and 1,404 pregnancies ( 12 , 16 – 19 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , …”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Anesthesia for fetal operative procedures: A systematic review

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,

²

,

³

et al. 2022

Front. Pain Res.

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ObjectiveThe anesthetic management of fetal operative procedures (FOP) is a highly debated topic. Literature on fetal pain perception and response to external stimuli is rapidly expanding. Nonetheless, there is no consensus on the fetal consciousness nor on the instruments to measure pain levels. As a result, no guidelines or clinical recommendations on anesthesia modality during FOP are available. This systematic literature review aimed to collect the available knowledge on the most common fetal interventions, and summarize the reported outcomes for each anesthetic approach. Additional aim was to provide an overall evaluation of the most commonly used anesthetic agents.MethodsTwo systematic literature searches were performed in Embase, Medline, Web of Science Core Collection and Cochrane Central Register of Controlled Trials up to December 2021. To best cover the available evidence, one literature search was mostly focused on fetal surgical procedures; while anesthesia during FOP was the main target for the second search. The following fetal procedures were included: fetal transfusion, laser ablation of placental anastomosis, twin-reversed arterial perfusion treatment, fetoscopic endoluminal tracheal occlusion, thoraco-amniotic shunt, vesico-amniotic shunt, myelomeningocele repair, resection of sacrococcygeal teratoma, ligation of amniotic bands, balloon valvuloplasty/septoplasty, ex-utero intrapartum treatment, and ovarian cyst resection/aspiration. Yielded articles were screened against the same inclusion criteria. Studies reporting anesthesia details and procedures’ outcomes were considered. Descriptive statistical analysis was performed and findings were reported in a narrative manner.ResultsThe literature searches yielded 1,679 articles, with 429 being selected for full-text evaluation. A total of 168 articles were included. Overall, no significant differences were found among procedures performed under maternal anesthesia or maternal-fetal anesthesia. Procedures requiring invasive fetal manipulation resulted to be more effective when performed under maternal anesthesia only. Based on the available data, a wide range of anesthetic agents are currently deployed and no consistency has been found neither between centers nor procedures.ConclusionsThis systematic review shows great variance in the anesthetic management during FOP. Further studies, systematically reporting intraoperative fetal monitoring and fetal hormonal responses to external stimuli, are necessary to identify the best anesthetic approach. Additional investigations on pain pathways and fetal pain perception are advisable.

“…Ninety-seven studies, accounting for 4,070 pregnancies, were included in the baseline characteristics and outcome analysis for MA ( 11 , 15 , 21 – 24 , 26 – 29 , 33 , 35 , 38 – 40 , 46 , 48 , 50 – 52 , 58 , 61 – 65 , 67 – 69 , 71 – 82 , 84 , 87 , 89 – 94 , 96 , 97 , 99 , 101 – 103 , 105 , 107 , 111 , 113 – 117 , 120 , 122 , 126 , 128 – 134 , 137 – 139 , 149 , 151 , 152 , 154 – 157 , 159 – 162 , 164 , 166 – 169 , 171 , 173 – 175 , 178 ). The aggregated mean GA at procedure, based on data from 85 studies (3,801 pregnancies), was 27.03 weeks ( 11 , 15 , 22 – 24 , 26 – 29 , 33 , 35 , 38 , 40 , …”

Section: Resultsmentioning

confidence: 99%

“…The aggregated mean GA at procedure, based on data from 85 studies (3,801 pregnancies), was 27.03 weeks ( 11 , 15 , 22 – 24 , 26 – 29 , 33 , 35 , 38 , 40 , 46 , 48 , 50 – 52 , 58 , 61 – 63 , 65 , 67 – 69 , 71 – 82 , 87 , 89 , 90 , 92 – 94 , 96 , 97 , 99 , 101 – 103 , 105 , 107 , 111 , 113 , 116 , 117 , 120 , 122 , 126 , 128 – 134 , 137 , 138 , 149 , 151 , 154 – 157 , 160 , 162 , 164 , 166 – 169 , 171 , 173 , 175 , 178 ). The mean LOH resulted to be 4.98 days, based on 24 studies involving 903 women ( 21 , 24 , 28 , 29 , 40 , 46 , 52 , 64 , 73 , …”

Section: Resultsmentioning

confidence: 99%

“…Ninety-five studies (3,905 pregnancies) were included for the comparative analysis of the anesthesia administration's routes ( 11 , 15 , 21 – 24 , 26 – 29 , 33 , 35 , 38 – 40 , 46 , 48 , 50 – 52 , 58 , 61 – 65 , 67 – 69 , 71 – 82 , 84 , 87 , 89 – 94 , 96 , 97 , 99 , 101 – 103 , 105 , 107 , 111 , 113 – 116 , 120 , 122 , 126 , 128 – 134 , 137 – 139 , 149 , 151 , 152 , 154 – 157 , 159 – 162 , 164 , 166 – 169 , 171 , 173 – 175 ). No statistically significant differences were found in the baseline characteristics and outcomes between patients receiving loco-regional and general anesthesia ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…MFA was provided in 1,551 procedures from 59 studies ( 12 , 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , 83 , 85 , 86 , 88 , 95 , 98 , 100 , 104 , 106 , 108 , 112 , 118 , 119 , 121 , 125 , 127 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 172 , 176 , 177 ). Fetal anesthesia administration was specified in 50 studies, consisting of 635 intramuscular injections (45 studies), 292 subcutaneous injections (three studies) and four intravenous injections (two studies) ( 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 , 44 , 47 , 49 , 50 , 52 , 54 , 55 ,…”

Section: Resultsmentioning

confidence: 99%

“…Fetal anesthesia administration was specified in 50 studies, consisting of 635 intramuscular injections (45 studies), 292 subcutaneous injections (three studies) and four intravenous injections (two studies) ( 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 , 44 , 47 , 49 , 50 , 52 , 54 , 55 , 57 , 59 , 63 , 83 , 86 , 95 , 98 , 100 , 104 , 106 , 108 , 118 , 119 , 121 , 125 , 127 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 176 , 177 ). An aggregate mean GA at procedure of 27.99 weeks was calculated on 49 studies and 1,404 pregnancies ( 12 , 16 – 19 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , …”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Anesthesia for fetal operative procedures: A systematic review

¹

,

²

,

³

et al. 2022

Front. Pain Res.

View full text Add to dashboard Cite

ObjectiveThe anesthetic management of fetal operative procedures (FOP) is a highly debated topic. Literature on fetal pain perception and response to external stimuli is rapidly expanding. Nonetheless, there is no consensus on the fetal consciousness nor on the instruments to measure pain levels. As a result, no guidelines or clinical recommendations on anesthesia modality during FOP are available. This systematic literature review aimed to collect the available knowledge on the most common fetal interventions, and summarize the reported outcomes for each anesthetic approach. Additional aim was to provide an overall evaluation of the most commonly used anesthetic agents.MethodsTwo systematic literature searches were performed in Embase, Medline, Web of Science Core Collection and Cochrane Central Register of Controlled Trials up to December 2021. To best cover the available evidence, one literature search was mostly focused on fetal surgical procedures; while anesthesia during FOP was the main target for the second search. The following fetal procedures were included: fetal transfusion, laser ablation of placental anastomosis, twin-reversed arterial perfusion treatment, fetoscopic endoluminal tracheal occlusion, thoraco-amniotic shunt, vesico-amniotic shunt, myelomeningocele repair, resection of sacrococcygeal teratoma, ligation of amniotic bands, balloon valvuloplasty/septoplasty, ex-utero intrapartum treatment, and ovarian cyst resection/aspiration. Yielded articles were screened against the same inclusion criteria. Studies reporting anesthesia details and procedures’ outcomes were considered. Descriptive statistical analysis was performed and findings were reported in a narrative manner.ResultsThe literature searches yielded 1,679 articles, with 429 being selected for full-text evaluation. A total of 168 articles were included. Overall, no significant differences were found among procedures performed under maternal anesthesia or maternal-fetal anesthesia. Procedures requiring invasive fetal manipulation resulted to be more effective when performed under maternal anesthesia only. Based on the available data, a wide range of anesthetic agents are currently deployed and no consistency has been found neither between centers nor procedures.ConclusionsThis systematic review shows great variance in the anesthetic management during FOP. Further studies, systematically reporting intraoperative fetal monitoring and fetal hormonal responses to external stimuli, are necessary to identify the best anesthetic approach. Additional investigations on pain pathways and fetal pain perception are advisable.

Is it time for the ‘OOPS’ to ‘EXIT’?

Powell,

Metodiev

2023

Anaesthesia Reports

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No abstract

Neuraxial anesthesia in ex utero intrapartum therapy for parturients with fetal congenital diaphragmatic hernia: a prospective observational study

Wang¹,

Pei²,

et al. 2022

International Journal of Obstetric Anesthesia

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No abstract

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