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In recent years, the significant advancement in imaging techniques has led to the early and detailed diagnoses of fetal abnormalities in utero. Some of these conditions may result in significant irreversible organ damage or even fetal death. Surgical intervention is required to correct these abnormalities when the fetus is still in utero during mid-gestation or immediately after delivery when the fetus is still on placental circulation (EXIT: Ex Utero Intrapartum Treatment procedure). These procedures pose a special challenge to the anesthesiologist, having to consider the unique maternal physiology and fetal physiology. This article reviews the role played by anesthesiologists as part of the interprofessional management of fetal surgeries and provides a brief overview of the anesthetic management of various fetal surgeries. Objectives: Describe different categories of fetal surgeries. Outline the principles and significance of anesthetic management for various fetal surgeries. Explain the complications of fetal anesthesia and troubleshooting to uncover them. Review how interprofessional coordination of activity can be of benefit in anesthetic management for various fetal surgeries. Access free multiple choice questions on this topic.

In recent years, the significant advancement in imaging techniques has led to the early and detailed diagnoses of fetal abnormalities in utero. Some of these conditions may result in significant irreversible damage to an organ or sometimes even death if not corrected before birth. Therefore, surgical intervention is required to correct these abnormalities when the fetus is still in utero during mid-gestation or immediately after delivery when the fetus is still on placental circulation (EXIT: Ex Utero Intrapartum Treatment procedure). Fetal surgeries, better termed maternal-fetal surgery, need a varying degree of analgesia, sedation, or anesthesia to both the mother and fetus for optimal operating conditions and favorable outcomes. Unlike conventional cesarean sections, they often need general anesthetic together with profound uterine relaxation, which is often continued after the procedure. Also, the fetus needs to be maintained on placental support for varying lengths of time. These surgeries should pose minimal risk to the parturient, which is often termed as “Innocent Bystander,” as she is exposed to the risk of surgery and anesthesia from which she receives no direct benefit. There should be sufficient data that the fetus will benefit from the surgery, and any other lethal fetal abnormality should be ruled out to qualify for the fetal surgeries. These procedures pose a special challenge to the anesthesiologist, having to consider the unique maternal physiology as well as the fetal physiology. Hence a complete understanding of maternal and fetal physiology, anesthetic principles, and anesthesia techniques are essential. This review article presents a brief overview of the various fetal surgeries and the anesthetic considerations specific to them.

Fetal surgeries are challenging endeavors, requiring collaboration between multiple teams, including but not limited to surgeons, otolaryngologists, obstetricians, neonatologists, feto-maternal physicians, anesthesiologists, nursing, and other ancillary staff. An inter-disciplinary discussion should be held in advance to create an elaborate plan. Shared decision-making should also involve the parturient to set expectations. These procedures are physically and emotionally taxing for the mother and could be associated with multiple complications for both the mother and the child. Thorough, closed-loop communication is monumental. The team should ensure a seamless continuation of care from the antenatal period into preoperative optimization and care in the operating room and care in the NICU to optimize maternal and fetal outcomes.