Anesthetic Considerations for Maternal-Fetal Interventions.

Area of Science:

• Anesthesiology
• Maternal-Fetal Medicine
• Surgical Innovation

Background:

• Maternal-fetal surgery (MFS) has advanced due to improved fetal anomaly diagnosis and management.
• MFS encompasses minimally invasive, open, and ex utero intrapartum treatment (EXIT) procedures.
• Anesthesia providers are integral to the multidisciplinary team managing MFS.

Purpose of the Study:

• To outline the unique anesthetic considerations for maternal-fetal surgery (MFS).
• To enhance knowledge for certified registered nurse anesthetists (CRNAs) regarding MFS anesthetic care.
• To promote safe anesthetic delivery in the growing subspecialty of MFS.

Main Methods:

• Review of anesthetic techniques for different MFS categories (minimally invasive, open, EXIT).
• Discussion of essential knowledge for anesthesia providers, including maternal and fetal physiology.
• Emphasis on managing risks associated with general anesthesia and maintaining uteroplacental blood flow.

Main Results:

• Anesthetic management varies by MFS type: open/EXIT procedures often need general anesthesia, while minimally invasive ones may use local anesthesia with sedation.
• Key anesthetic challenges include managing pregnancy-related physiological changes, fetal immobility, uterine atony, and fetal resuscitation.
• Understanding the specific fetal condition and surgical plan is crucial for optimal anesthetic care.

Conclusions:

• Maternal-fetal surgery (MFS) presents distinct anesthetic challenges requiring specialized knowledge.
• Certified registered nurse anesthetists (CRNAs) can provide safer anesthesia by familiarizing themselves with MFS principles.
• This educational course aims to improve anesthetic care standards in maternal-fetal surgery.