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Anesthesia for fetal operative procedures: A systematic review
Miriam Duci1, Rebecca Pulvirenti1, Francesco Fascetti Leon1
1Pediatric Surgery Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy.
Frontiers in Pain Research (Lausanne, Switzerland)
|October 17, 2022
Summary
Anesthetic management for fetal operative procedures (FOP) lacks consensus. This review found no significant differences between maternal or maternal-fetal anesthesia, though maternal anesthesia alone may be more effective for invasive procedures.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Fetal Medicine
Background:
- Anesthetic management for fetal operative procedures (FOP) is controversial.
- There is a lack of consensus on fetal pain perception, consciousness, and measurement tools.
- Consequently, no established guidelines exist for anesthesia during FOP.
Purpose of the Study:
- To systematically review existing literature on common FOPs.
- To summarize outcomes associated with different anesthetic approaches during FOP.
- To evaluate commonly used anesthetic agents in FOP.
Main Methods:
- Conducted two systematic literature searches in major databases (Embase, Medline, Web of Science, Cochrane) up to December 2021.
- Included studies on various FOPs such as fetal transfusion, laser ablation, and myelomeningocele repair.
- Analyzed 168 articles reporting anesthesia details and procedure outcomes, presenting findings narratively.
Main Results:
- No significant differences in outcomes were observed between maternal anesthesia and maternal-fetal anesthesia.
- Procedures involving invasive fetal manipulation appeared more effective under maternal anesthesia alone.
- A wide variety of anesthetic agents are used inconsistently across centers and procedures.
Conclusions:
- Significant variance exists in anesthetic management for FOP.
- Further research is needed on intraoperative fetal monitoring and hormonal responses to stimuli.
- Additional studies on fetal pain pathways and perception are recommended to guide best practices.
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