Total intravenous anesthesia for open fetal myelomeningocele repair: a case series from a single-center in Peru (2017-2025).

BACKGROUND

Open fetal myelomeningocele repair requires maternal general anesthesia and profound uterine relaxation. Total intravenous anesthesia may be an alternative to volatile anesthetics. We describe our anesthetic approach and maternal, fetal, surgical, and neonatal outcomes.

METHODS

We retrospectively reviewed 25 cases of open fetal myelomeningocele repairs performed from January 2017 to July 2025. The anesthetic protocol comprised target-controlled infusions of propofol and remifentanil guided by bispectral index monitoring, neuromuscular blockade, intravenous uterine relaxation, and intramuscular fetal atropine, fentanyl, and vecuronium.

RESULTS

All 25 procedures were completed under total intravenous anesthesia without use of volatile anesthetics. Combined magnesium sulfate and nitroglycerin were used for uterine relaxation in 60% of cases. Fetal bradycardia occurred in one case (4%), and no cases of maternal pulmonary edema occurred. Median gestational age at delivery was 36 weeks.

DISCUSSION: Total intravenous anesthesia combined with intravenous uterine relaxants was feasible for open fetal myelomeningocele repair in this case series.