Peri-operative management of percutaneous fetoscopic spina-bifida repair: a descriptive review of five cases from the United Kingdom, with focus on anaesthetic implications

Goonasekera, Chulananda; Skelton, V.; Zebian, Bassel; Nicolaides, Kypros H.; Lapa, D.A.; Santorum-Perez, M.; Bleil, Cristina; Hickey, Ann; Bhat, Ravindra; Gatto, Bruno Emanuel Oliva

doi:10.1016/j.ijoa.2020.04.005

Cited by 6 publications

(6 citation statements)

References 69 publications

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“…La anestesia general se realiza con inducción de secuencia rápida, así fármacos como el propofol a dosis de 2 mg/kg, fentanil a dosis de 1 a 2 µg/kg o remifentanil a dosis de 0,5 µg/kg. El relajante muscular sigue siendo la succinilcolina a mg/kg para así realizar la intubación en los primeros 45-60 segundos [3].…”

Section: Discussionunclassified

“…La relajación uterina es un paso crítico en este tipo de procedimientos para propiciar las condiciones ideales para la exposición fetal, por lo que el uso de halogenados a dosis elevadas (al menos 2 CAM) para obtener relajación uterina profunda, sin embargo, se ha demostrado que a 2,4 CAM o mayores re- duce el flujo umbilical durante el procedimiento quirúrgico, así como estudios que reportan efectos adversos a nivel de sistema nervioso central y cardiaco haciendo especial énfasis en la disfunción ventricular y valvular en el feto y la madre; por lo que se puede administrar infusión de nitroglicerina desde 0,5 a 1 mcg/kg/min con bolos de rescate entre 50-200 mcg intravenosos y así lograr disminuir el requerimiento de los anestésicos inhalados para la relajación uterina. A partir de la histerorrafia se utiliza sulfato de magnesio en dosis de carga de 4 a 6 g intravenoso en 30 minutos posteriormente se continua con infusión a 1-2 g/h manteniéndola hasta 48 h posquirúrgicas; también es posible utilizar atosiban intravenoso, nifedipino oral o terbutalina subcutánea como regímenes posoperatorios para tocolisis [2], [3].…”

Section: Discussionunclassified

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Corrección de mielomeningocele intrautero: Reporte del primer caso en Ecuador

Roldán¹,

Mora²,

Zambrano³

et al. 2021

Rev. chil. anest.

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This is the case of a 26 year old patient, at week 27 of gestational age and with a prenatal diagnosis of myelomeningocele. It was decided to enter the clinic to perform the first correction of the spina bifida defect in Ecuador, with the support of a multidisciplinary team of national and foreign professionals. This procedure was carried out within international parameters and standards for the management of this pathology, with the equipment, supplies and trained personnel to carry this surgery to a successful outcome, both for the fetus and its mother. It is demonstrated that our country has the capacity of both human resources and equipment to solve highly complex pathologies.

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Section: Discussionunclassified

Corrección de mielomeningocele intrautero: Reporte del primer caso en Ecuador

Roldán¹,

Mora²,

Zambrano³

et al. 2021

Rev. chil. anest.

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“…Fetal well-being may be monitored by Doppler assessment of Pulsatility Index (PI) placing the ultrasound probe in the maternal flank. PI is calculated as the difference between systolic and diastolic umbilical arterial blood flow velocities divided by its mean, [19,19,65]. Umbilical artery pulsatility is governed by fetal cardiac output and the resistance to flow.…”

Section: Umbilical or Middle Cerebral Artery Flow Measurersmentioning

confidence: 99%

“…However, a reduction in UA-PI indices may be seen due to fetal hypovolemia [74] and fetal anesthesia [75,76]. In addition, the flow may be reduced by external compression of the umbilical cord by the CO 2 inflation pressure within the uterus [19]. Fetal hypovolemia in twin-twin transfusion syndrome and fetal demise was better predicted by qualitative assessment of umbilical artery end diastolic flow than by UA-PI, with reduced end diastolic flow in UA an indicator of compromise [77].…”

Section: Umbilical or Middle Cerebral Artery Flow Measurersmentioning

confidence: 99%

“…Limited reliability of monitoring risks complications and poor outcomes. The need for this review was triggered by our initial experiences (9 cases) in the UK on the subject [19] and focuses on fetal monitoring technologies used during fetoscopic fetal spina-bifida surgery to date, their suitability to ensure fetal safety and areas needing improvement.…”

Section: Introductionmentioning

confidence: 99%

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Fetal Safety During Fetoscopic Spina-Bifida Repair: Anesthetic Concerns

Goonasekera

Skelton

2021

Journal of Fetal Medicine

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Prenatal repair of fetal spina-bifida in the 2nd trimester has been shown to improve neurological function after delivery of the baby. Surgery can be performed with partial delivery of the fetus through a uterine incision, or increasingly via fetoscopy. Trocars to allow surgical instrumentation are introduced either via the exteriorized uterus or percutaneously. Both approaches require maternal anesthesia, an immobile anesthetized fetus and a noncontracting uterus. This can be achieved with administration of a general anesthetic to the mother, transplacental anesthesia of the fetus and tocolytic agents as required. Transplacental anesthesia needs to balance adequate depth of anesthesia for the mother and fetus with rapidly reversible uterine atony. The anesthetist is responsible for the safety of both patients. Monitoring of cardio-respiratory parameters for the mother are well established, but the tools available to monitor fetal well-being and access for corrective therapy are limited. Cardiotocography, fetal echocardiography or ultrasound assessment of umbilical or middle cerebral artery blood flow can be monitored for fetal well-being, but interpretation can be difficult. Fetal blood pressure monitoring is not yet feasible. There is a clear need to enhance fetal monitoring and define normal parameters with clear protocols for intervention to improve fetal safety. Abandoning the procedure should be considered to avoid emergency delivery of an extremely premature fetus. More research into suitable fetal monitoring techniques are needed.

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Cefuroxime/indometacin

2020

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Peri-operative management of percutaneous fetoscopic spina-bifida repair: a descriptive review of five cases from the United Kingdom, with focus on anaesthetic implications

Cited by 6 publications

References 69 publications

Corrección de mielomeningocele intrautero: Reporte del primer caso en Ecuador

Corrección de mielomeningocele intrautero: Reporte del primer caso en Ecuador

Fetal Safety During Fetoscopic Spina-Bifida Repair: Anesthetic Concerns

Cefuroxime/indometacin

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