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Anesthesia for predelivery procedures

ex-utero intrapartum treatment/intrauterine transfusion/surgery of the fetus

Weber, Stefan U.a,b; Kranke, Peterc

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 291–297
doi: 10.1097/ACO.0000000000000718
OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Emilia Guasch and Manuel Wenk
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Purpose of review The aim of this study was to review the current literature on anesthesia for predelivery procedures and to summarize recent findings on anesthesiological methods used.

Recent findings Ex-utero intrapartum treatment (EXIT)-procedures are performed to secure the newborn's oxygenation in case of severe airway obstruction due to multiple conditions. A key feature of EXIT is continued intactness of the maternofetal circulation by uterine relaxation achieved by general anesthesia with high doses of anesthetic gases. A dose reduction may be achieved by combining inhaled anesthesia with propofol. After intrauterine transfusion the anesthesia team needs to be prepared for a potential need of emergency cesarean section. Temporary fetal endoluminal tracheal occlusion and laser coagulation for twin-to-twin transfusion syndrome may be either performed in monitored anesthesia care or neuraxial anesthesia. Neuraxial anesthesia also is a method of choice for fetal valvuloplasty and amniotic band release. Fetal myelomenigocele repair requires general anesthesia with tocolysis.

Summary Predelivery procedures require a differentiated anesthesia approach depending on the invasiveness of the intervention. Anesthesia ranges from monitored care to neuraxial anesthesia and general anesthesia. Depending on the procedure uterine relaxation and fetal immobilization are crucial for technical success. Interdisciplinary consultation optimizes the anesthesia plan for complex procedures.

aDepartment of Anesthesiology and Intensive Care Medicine, Heilig Geist-Krankenhaus Köln

bDepartment of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn

cDepartment of Anesthesia and Critical Care Medicine, University Hospital of Würzburg, Würzburg, Germany

Correspondence to Stefan U. Weber, Department of Anesthesiology and Intensive Care Medicine, Heilig Geist-Krankenhaus, Grasseggerstraße 105, 50737 Köln, Germany. Tel: +49 221 491 8280; e-mail: stefan.weber1@cellitinnen.de

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