Anesthetic management of hysterotomy plus open in utero repair of myelomeningocele (spina bifida)
Manejo anestésico en histerotomía más corrección intrauterina de espina bífida abierta o mielomeningocele
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The correct implementation of pediatric and obstetric anesthesia is crucial to allow optimal surgical outcomes in pregnant women diagnosed with fetal myelomeningocele (MMC). The purpose of repairing MMC before birth is reducing the need of ventriculoperitoneal shunting and improving lower limbs motor function. This surgical challenge carries a greater chance of maternal morbidity, uterine dehiscence, uterine rupture secondary to hysterotomy and requiring cesarean delivery for this and all future pregnancies. This non-systematic review of the literature on anesthetic management of the mother-fetus binomial with CMM aims to socialize the best perioperative anesthesia strategy to manage these patients to the anesthesiology service.
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- Heuer GG, Moldenhauer JS, Adzick NS. Prenatal surgery for myelomeningocele: review of the literature and future directions. Childs Nerv Syst. 2017;33(7):1149-1155. doi: 10.1007/s00381-017-3440-z
- Pérez-Calatayud AA, Linarte-Basilio ME, de León Ponce MD, Carrillo Esper R,
- Briones-Garduño JC. Monitoreo hemodinamico no invasivo y minimamente invasivo en la paciente obstétrica. Med Crit. 2017;31(5):275-284.
- Andropoulos DB. Effect of anesthesia on the developing brain: infant and fetus. Fetal Diagn Ther. 2018;43(1):1-11. doi: 10.1159/000475928
- Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth. 2011;107 Suppl 1:i72-8. doi: 10.1093/bja/aer343.
- Belfort MA, Whitehead WE, Shamshirsaz AA, Bateni ZH, Olutoye OO, Olutoye OA, et al. Fetoscopic open neural tube defect repair: development and refinement of a two-port, carbon dioxide insufflation technique. Obstet Gynecol. 2017;129(4):734-743. doi: 10.1097/AOG.0000000000001941
- Palanisamy A. Maternal Anesthesia and fetal neurodevelopment. Int J Obstet Anesth. 2012;21(2):152-62. doi: 10.1016/j.ijoa.2012.01.005
- Bolaños-Arboleda D, Fonseca-Ruiz NJ, Socha-García NI, García-Peñuela E, Monsalve-Mejía G. Etilefrina vs. fenilefrina en hipotensión por anestesia espinal para cesárea. Rev Colomb Anestesiol. 2016;44(2):89–96. doi: 10.1016/j.rca.2016.01.008
- Devoto JC, Alcalde JL, Otayza F, Sepulveda W. Anesthesia for myelomeningocele surgery in fetus. Childs Nerv Syst. 2017;33(7):1169-1175. doi: 10.1007/s00381-017-3437-7
- Carreras E, Maroto A, Arévalo S, Rodó C, García-Fontecha CG, et al. Tratamiento prenatal del mielomeningocele. Diagnprenat. 2012;23(4):148–53. doi: 10.1016/j.diapre.2012.06.006
- Danzer E, Finkel R, Gerdes M, Schwartz EM, Rintoul NN, et al. The relationship of seizure activity and chronic epilepsy in early infancy and short-term neurodevelopmental outcome following fetal myelomeningocele closure. Neuropediatrics. 2010;41(3):140-3. doi: 10.1055/s-0030-1263164
- Wilson RD, Lemerand K, Johnson MP, Flake AW, Bebbington M, et al. Reproductive outcomes in subsequent pregnancies after a pregnancy complicated by open maternal-fetal surgery (1996-2007). Am J Obstet Gynecol. 2010;203(3):209.e1-6. doi: 10.1016/j.ajog.2010.03.029
- Garcia PJ, Olutoye OO, Ivey RT, Olutoye OA. Case scenario: Anesthesia for maternal-fetal surgery. The ex utero intrapartum therapy (EXIT) Procedure. Anesthesiology. 2011;114(6):1446-52. doi: 10.1097/ALN.0b013e31821b173e
- Kohl T. Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part I: surgical technique and perioperative outcome. ltrasound Obstet Gynecol. 2014;44(5):515-24. doi: 10.1002/uog.13430
- Luks FI. New and/or improved aspects of fetal surgery. Prenat Diagn. 2011;31(3):252-8. doi: 10.1002/pd.2706
- Phillips LA, Burton JM, Evans SH. Spina Bifida Management. In: JM B, editor. Curr Probl Pediatr Adolesc Health Care. 2017;47(7):173-177. doi: 10.1016/j.cppeds.2017.06.007
- Creeley CE, Dikranian KT, Dissen GA, Back SA, Olney JW. Isoflurane-induced apoptosis of neurons and oligodendrocytes in the fetal rhesus macaque brain. Anesthesiology. 2014;120(3):626-38. doi: 10.1097/ALN.0000000000000037
- Martins Santana EF, Moron AF, Mendes Barbosa M, Figuinha Milani HJ, Pereira Sarmento SG, et al. Fetal heart rate monitoring during intrauterine open surgery for myelomeningocele repair. Fetal Diagn Ther. 2016;39(3):172-8. doi: 10.1159/000438508
- Watanabe M, Kim AG, Flake AW. Tissue engineering strategies for fetal myelomeningocele repair in animal models. Fetal Diagn Ther. 2015;37(3):197-205. doi: 10.1159/000362931
- Fontecha CG, Peiro JL, Sevilla JJ, Aguirre M, Soldado F, et al. Fetoscopic coverage of experimental myelomeningocele in sheep using a patch with surgical sealant. Eur J Obstet Gynecol Reprod Biol.2011;156(2):171-6. doi: 10.1016/j.ejogrb.2010.12.046
- Rychik J, Cohen D, Tran KM, Szwast A, Natarajan SS, Johnson MP, et al. The Role of Echocardiography in the Intraoperative Management of the Fetus Undergoing Myelomeningocele Repair. Fetal Diagn Ther. 2015;37(3):172-8. doi: 10.1159/000364863
- Welzing L, Ebenfeld S, Dlugay V, J Wiesen MH, Roth B, Mueller C. Remifentanil degradation in umbilical cord blood of preterm infants. Anesthesiology. 2011;114(3):570-7. doi: 10.1097/ALN.0b013e318204e043
- Encinas JL, García-Cabezas MA, Barkovich J, Fontecha CG, Peiró JL, et al. Maldevelopment of the cerebral cortex in the surgically induced model of myelomeningocele: implications for fetal neurosurgery. J Pediatr Surg. 2011;46(4):713-722. doi: 10.1016/j.jpedsurg.2010.11.028
- Suehara T, Morishita J, Ueki M, Ueno M, Maekawa N, et al. Effects of sevoflurane exposure during late pregnancy on brain development of offspring mice. Paediatr Anaesth. 2016;26(1):52-9. doi: 10.1111/pan.12785