Nath Gita, Subrahmanyam M, Jayanthi R, Singh Ranju, Ramesh S, Ahuja Vanita
Department of Anaesthesia and Intensive Care, Axon Anaesthesia Associates, Hyderabad, Telangana, India.
Department of Anaesthesia, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India.
Indian J Anaesth. 2023 Jan;67(1):11-18. doi: 10.4103/ija.ija_964_22. Epub 2023 Jan 21.
Advances in prenatal diagnostic techniques have enabled early detection of potentially correctable foetal anomalies. Here, we summarise recent developments in anaesthesia for foetal surgery. Types of foetal surgery include minimally invasive, open mid-gestational and ex-utero intrapartum treatment (EXIT) procedures. Foetoscopic surgery avoids hysterotomy, with risk of uterine dehiscence, preserving the possibility of subsequent vaginal delivery. Minimally invasive procedures are performed under local or regional anaesthesia; open or EXIT procedures are usually done under general anaesthesia. Requirements include maintenance of uteroplacental blood flow, and uterine relaxation to prevent placental separation and premature labour. Foetal requirements include monitoring of well-being, providing analgesia and immobility. EXIT procedures require maintenance of placental circulation till the airway is secured, requiring multidisciplinary involvement. Here, the uterine tone must return after baby delivery to prevent major maternal haemorrhage. The anaesthesiologist plays a crucial role in maintaining maternal and foetal homeostasis and optimising surgical conditions.
产前诊断技术的进步使得早期发现潜在可纠正的胎儿异常成为可能。在此，我们总结了胎儿手术麻醉的最新进展。胎儿手术类型包括微创、孕中期开放性手术和产时宫外治疗（EXIT）手术。胎儿镜手术避免了子宫切开术及其子宫裂开风险，保留了后续阴道分娩的可能性。微创手术在局部或区域麻醉下进行；开放性或EXIT手术通常在全身麻醉下进行。要求包括维持子宫胎盘血流以及子宫松弛以防止胎盘分离和早产。胎儿方面的要求包括监测胎儿健康状况、提供镇痛和制动。EXIT手术需要在确保气道安全之前维持胎盘循环，这需要多学科参与。在此过程中，胎儿娩出后子宫张力必须恢复以防止产妇大出血。麻醉医生在维持母婴体内稳态和优化手术条件方面发挥着关键作用。
