Anesthesia for in utero repair of myelomeningocele
- PMID: 23508219
- PMCID: PMC3755883
- DOI: 10.1097/ALN.0b013e31828ea597
Anesthesia for in utero repair of myelomeningocele
Abstract
Recently published results suggest that prenatal repair of fetal myelomeningocele is a potentially preferable alternative when compared to postnatal repair. In this article, the pathology of myelomeningocele, unique physiologic considerations, perioperative anesthetic management, and ethical considerations of open fetal surgery for prenatal myelomeningocele repair are discussed. Open fetal surgeries have many unique anesthetic issues such as inducing profound uterine relaxation, vigilance for maternal or fetal blood loss, fetal monitoring, and possible fetal resuscitation. Postoperative management, including the requirement for postoperative tocolysis and maternal analgesia, are also reviewed. The success of intrauterine myelomeningocele repair relies on a well-coordinated multidisciplinary approach. Fetal surgery is an important topic for anesthesiologists to understand, as the number of fetal procedures is likely to increase as new fetal treatment centers are opened across the United States.
Figures
![Figure 1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/3755883/bin/nihms499443f1.gif)
![Figure 2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/3755883/bin/nihms499443f2.gif)
![Figure 3](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/3755883/bin/nihms499443f3.gif)
![Figure 4](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/3755883/bin/nihms499443f4.gif)
![Figure 5](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/3755883/bin/nihms499443f5.gif)
Comment in
-
In utero myelomeningocele repair: baby steps and giant leaps for fetal surgery.Anesthesiology. 2013 May;118(5):1016-8. doi: 10.1097/ALN.0b013e31828ea497. Anesthesiology. 2013. PMID: 23508218 No abstract available.
Similar articles
-
In utero myelomeningocele repair: baby steps and giant leaps for fetal surgery.Anesthesiology. 2013 May;118(5):1016-8. doi: 10.1097/ALN.0b013e31828ea497. Anesthesiology. 2013. PMID: 23508218 No abstract available.
-
Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial.Am J Obstet Gynecol. 2016 Jan;214(1):111.e1-111.e11. doi: 10.1016/j.ajog.2015.09.065. Epub 2015 Sep 18. Am J Obstet Gynecol. 2016. PMID: 26386383 Clinical Trial.
-
Open fetal myelomeningocele repair at a university hospital: surgery and pregnancy outcomes.Arch Gynecol Obstet. 2021 Dec;304(6):1443-1454. doi: 10.1007/s00404-021-06066-y. Epub 2021 May 1. Arch Gynecol Obstet. 2021. PMID: 33932174
-
Anesthesia for myelomeningocele surgery in fetus.Childs Nerv Syst. 2017 Jul;33(7):1169-1175. doi: 10.1007/s00381-017-3437-7. Epub 2017 May 25. Childs Nerv Syst. 2017. PMID: 28547209 Review.
-
Prenatal surgery for myelomeningocele.Curr Opin Obstet Gynecol. 2016 Apr;28(2):111-8. doi: 10.1097/GCO.0000000000000253. Curr Opin Obstet Gynecol. 2016. PMID: 26866841 Review.
Cited by
-
Perioperative management of patients with spina bifida.BJA Educ. 2024 Jun;24(6):203-209. doi: 10.1016/j.bjae.2024.02.004. Epub 2024 Mar 27. BJA Educ. 2024. PMID: 38764443 Review. No abstract available.
-
Implementation and Assessment of a Laparotomy-Assisted Three-Port Fetoscopic Spina Bifida Repair Program.J Clin Med. 2023 Aug 7;12(15):5151. doi: 10.3390/jcm12155151. J Clin Med. 2023. PMID: 37568553 Free PMC article.
-
Decreased Maternal Morbidity and Improved Perinatal Results of Magnesium-Free Tocolysis and Classical Hysterotomy in Fetal Open Surgery for Myelomeningocele Repair: A Single-Center Study.Biomedicines. 2023 Jan 28;11(2):392. doi: 10.3390/biomedicines11020392. Biomedicines. 2023. PMID: 36830929 Free PMC article.
-
Use of Remifentanil for Open in utero Fetal Myelomeningocele Repair Maintains Uterine Relaxation with Reduced Volatile Anesthetic Concentration.Fetal Diagn Ther. 2020;47(11):810-816. doi: 10.1159/000509384. Epub 2020 Sep 10. Fetal Diagn Ther. 2020. PMID: 32911467 Free PMC article.
-
Evaluation of pulse wave transit time analysis for non-invasive cardiac output quantification in pregnant patients.Sci Rep. 2020 Feb 5;10(1):1857. doi: 10.1038/s41598-020-58910-x. Sci Rep. 2020. PMID: 32024981 Free PMC article.
References
-
- Shaer CM, Chescheir N, Schulkin J. Myelomeningocele: A review of the epidemiology, genetics, risk factors for conception, prenatal diagnosis, and prognosis for affected individuals. Obstet Gynecol Surv. 2007;62:471–9. - PubMed
-
- Boulet SL, Yang Q, Mai C, Kirby RS, Collins JS, Robbins JM, Meyer R, Canfield MA, Mulinare J. Trends in the postfortification prevalence of spina bifida and anencephaly in the United States. Birth Defects Res A Clin Mol Teratol. 2008;82:527–32. - PubMed
-
- Mitchell LE, Adzick NS, Melchionne J, Pasquariello PS, Sutton LN, Whitehead AS. Spina bifida. Lancet. 2004;364:1885–95. - PubMed
-
- Thompson DN. Postnatal management and outcome for neural tube defects including spina bifida and encephalocoeles. Prenat Diagn. 2009;29:412–9. - PubMed
-
- Davis BE, Daley CM, Shurtleff DB, Duguay S, Seidel K, Loeser JD, Ellenbogan RG. Long-term survival of individuals with myelomeningocele. Pediatr Neurosurg. 2005;41:186–91. - PubMed
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical