Anesthesia for fetal surgery.

PURPOSE OF REVIEW: To look at different anesthetic approaches to different surgical techniques used in fetal procedures and the influence of maternal and fetal factors on anesthetic management.

RECENT FINDINGS: Fetal surgery is evolving rapidly in the field of mainly ex-utero intrapartum treatment procedures, where new indications are found and new anesthetic techniques are developed, enabling the use of locoregional anesthesia. Further development of anesthetic techniques focuses on minimizing the risks for the mother and preserving the normal neurodevelopment of the fetus.

SUMMARY: Open fetal surgery remains a major invasive procedure for mother and fetus both, requiring general anesthesia with adequate invasive monitoring. Minimal invasive fetal procedures can be performed with local anesthesia alone or, for the more complex fetoscopic procedures, with a neuraxial locoregional technique. Fetal anesthesia and analgesia can then be provided by different routes. Ex-utero intrapartum treatment procedures are open fetal procedures, but they can be performed with locoregional anesthesia, when uterine relaxation can be achieved without volatile anesthetics with the use of intravenous nitroglycerin.