Anesthesia for Fetal Intervention and Surgery

Fetal surgical interventions are broadly categorized into three different kinds of procedures: open procedures, minimally invasive or percutaneous procedures, and ex utero intrapartum treatment. This chapter summarizes the rationale for fetal intervention, a description of both surgical and anesthetic considerations, and a review of outcome data. The indications include congenital diaphragmatic hernia, twin–twin transfusion syndrome, twin reversed arterial perfusion sequence, and myelomeningocele. Details of anesthetic techniques are presented in the chapter. Anesthetic management of fetal surgical procedures is similar to anesthesia for non-obstetric surgery during pregnancy; the paramount focus must be on maternal safety. The chapter also presents the perioperative and procedural considerations including the risks and benefits to fetus and mother, the intraoperative and postoperative considerations, and the issue of postoperative management.