Fetal surgery, anaesthesiological considerations

Abstract

Refined techniques and skills have enabled sophisticated prenatal diagnosis in utero and resulted in the newly evolving specialty of fetal surgery in a few centres worldwide. Most of the procedures performed today have been preceded by extensive experimental research in animals, whereas fetal anaesthesia is mainly based on clinical experience and a few studies performed in pregnant sheep. Major limitations of fetal surgery include the high frequency of preterm labour and delivery which may offset any fetal benefit of the surgical procedure. The development of more potent tocolytic drugs than the drugs currently available may thus be compared to the meaning of potent immunosuppressive agents in organ transplantation. Fetal mortality and maternal morbidity consequently lead to a more cautious way of treatment, as with the development of endoscopic fetal surgery. The invasive fetal surgery is still considered as being in a research stage in most cases. Therefore most procedures are performed as minimally invasive, avoiding substantial risks by accessing the uterus through minimal openings. Some new devices are under investigation for monitoring the myometrial electrical activity and mechanical contractility and the fetal electroencephalogram, the continuous monitoring of the fetal arterial oxygen saturation, PO2 and PCO2, and for monitoring fetal cerebral oxygenation, blood volume and blood flow by near infrared spectroscopy.