Anesthetic management of open fetal surgery to correct spina bifida
Background. Today, open fetal surgery is a rare intervention, the main goal of which is to correct intrauterine fetal malformations. Studies have provided evidence that intrauterine correction of spina bifida reduces the incidence and severity of neurological disorders, compared with the standard surgical treatment for newborns. Anesthetic management of open fetal surgery is complex and differs from the standard anesthesia management during pregnancy.Ostrik K.A., Pyregov A.V., Gladkova K.A., Kostyukov K.V., Shmakov R.G.
Case report. The paper describes two clinical cases of anesthesia of an open fetal surgical intervention for congenital malformation – myelomeningocele (spina bifida). The surgery was performed in the second trimester of pregnancy. Pregnant women underwent combined anesthesia with high doses of an inhalation anesthetic. This clinical case demonstrates the features of anesthesia and the approach to choosing the tactics for anesthetic management of open fetal surgery. It shows that such operations cannot be performed without well-coordinated work of a large multidisciplinary team of professionals.
Conclusion. Fetal surgery is a rapidly growing field of medicine. Anesthetic management of fetal surgery is developing together with progress in surgical techniques. Anesthetic management is based on knowledge of the physiology and pathophysiology of the mother and fetus. Open fetal surgery cannot be performed without the multidisciplinary teamwork of professionals, who include obstetricians/gynecologists, neurosurgeons, anesthesiologists/resuscitators, neonatologists, fetal medicine specialists, operating nurses, anesthetic nurses, and midwives; operating rooms prepared with appropriate equipment are also needed.
Keywords
open fetal surgery
general anesthesia
fetal anesthesia
fetal medicine
multidisciplinary interaction
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Received 02.06.2020
Accepted 06.06.2020
About the Authors
Kirill A. Ostrik, anesthesiologist-resuscitator, V.I. Kulakov NMRC for OG&P of the Ministry of Health of Russia. Tel.: +7(909)980-13-17. E-mail: Kirillplatonovich@yandex.ru.117997, Russia, Moscow, Academician Oparin str., 4.
Aleksey V. Pyregov, Doctor of Medical Sciences, Professor, Director of the Institute of Anesthesiology,
Intensive Care and Transfusiology, V.I. Kulakov NMRC for OG&P of the Ministry of Health of Russia.
Tel.: +7(916)140-65-49. E-mail: Pyregov@mail.ru. 117997, Russia, Moscow, Academician Oparin str., 4.
Kristina A. Gladkova, Ph.D., senior researcher, Department of Fetal Medicine, Institute of Obstetrics, Head of the 1st Obstetric Department of Pregnancy Pathology,
V.I. Kulakov NMRC for OG&P of the Ministry of Health of Russia. Tel.: +7(916)321-10-07. E-mail: oeluneke@gmail.com. 117997, Russia, Moscow, Academician Oparin str., 4.
Kirill V. Kostyukov, MD, PhD, senior researcher, Department of Fetal Medicine, Institute of Obstetrics, Physician, Department of Functional and Ultrasound Diagnostics, Department of Visual Diagnostics, V.I. Kulakov NMRC for OG&P of the Ministry of Health of Russia.
Tel.: +7(926)214-97-84. E-mail:kosrykov_k@yahoo.com. 117997, Russia, Moscow, Academician Oparin str., 4.
Roman G. Shmakov, Doctor of Medical Sciences, Professor of the Russian Academy of Sciences, Director of the Institute of Obstetrics,
V.I. Kulakov NMRC for OG&P of the Ministry of Health of Russia. E-mail: mdshmakov@mail.ru. 117997, Russia, Moscow, Academician Oparin str., 4
For citation: Ostrik K.A., Pyregov A.V., Gladkova K.A., Kostyukov K.V., Shmakov R.G. Anesthetic management of open fetal surgery to correct spina bifida.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 9: 255-261 (in Russian).
https://dx.doi.org/10.18565/aig.2020.9.255-261
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