Anesthesia for Fetal Surgery
What Is Anesthesia for Fetal Surgery?
Fetal surgery, or surgery on a pregnant mother in order to help her baby, can occur either during the middle of pregnancy or at the end of the pregnancy. In all cases, anesthesiologists are involved to provide for the comfort and safety of pregnant mothers and their babies.
Reasons for Fetal Surgery
Fetal surgery scheduled in the middle of pregnancy, or "midgestation", may be for many different conditions, including:
Minimally Invasive Fetal Surgery
Many of these surgeries during the middle of pregnancy can be done with a "minimally invasive" technique. This means the surgeon uses small cameras placed through a few small incisions in the mother's belly in order to operate on the baby, the umbilical cord, or the placenta. Since these small cameras are called "scopes," this is often referred to as "fetoscopy". Usually the mother is kept comfortable during fetoscopy with local anesthetics (like Novocain at the dentist) or with epidural medicines (that make her numb from the waist down).
Additional medicine can be given to the mother through an IV (intravenous) catheter to help her relax and make the surgery go by more quickly.
Open Fetal Surgery
Some of the fetal surgery in the middle of pregnancy cannot be done using the scopes, and require an incision through the mother's abdomen and uterus in order to operate on the baby. Because of the uterine incision, it is necessary that the mother be given anesthetic gases to breathe to keep the uterus from contracting. Therefore, both mother and baby are given general anesthesia for these "open" fetal surgeries. When patients are under general anesthesia, they are unconscious and cannot feel pain or any other sensation.
Fetal Surgery at the End of Pregnancy
The other type of fetal surgery happens at the end of pregnancy. This specialized fetal surgery to help deliver the baby safely is called Ex Utero Intrapartum Therapy, or EXIT for short. This kind of fetal surgery can be for:
- Large head or neck tumors that require a specialized breathing tube right after delivery
- Severe heart or lung problems requiring immediate support with a specialized heart-lung machine (ECMO or extra corporeal membrane oxygenation)
This EXIT surgery for delivery of the baby also requires an incision through the mother's abdomen, so both mother and baby are given general anesthesia for these fetal surgeries as well. Again, general anesthesia prevents pain an all other sensations during the surgery.
Before Surgery
Before surgery, you will meet your anesthesiologist. You will be asked questions about your medical history, allergies, current medications, previous anesthetic experiences and current health status. The anesthesiologist will examine your airway, heart and lungs. He or she will ask questions about your baby's gestational age, any tests and procedures done during pregnancy, and any known abnormalities that the baby may have.
After your anesthesiologist reviews your entire medical history as well as laboratory tests, he or she will discuss with you the risks and benefits of the type of anesthesia that is recommended for your surgery. Usually, the minimally invasive surgery (with the small incisions) has epidural anesthesia, and the fetal surgeries which require a larger incision for the mother (either in the middle of pregnancy or at the end) have general anesthesia.
Day of Surgery
On the day of surgery, you will come to the Same Day Surgery area of Cincinnati Children's Hospital Medical Center for check-in. Before going to the Operating Room, you will change into a hospital gown and have an intravenous (IV) catheter placed. You may receive some medicine through the IV to help you relax just before leaving for the operating room.
After arriving in the operating room, you will sit up on the bed to have your epidural placed (if one is going to be used for your surgery). Once the epidural is in place, you will lie down and routine equipment will check on your heart's electrical activity, your blood pressure, and the oxygen levels in your blood.
If you are having fetoscopy, you may receive additional medicine to relax you, and you may even take a nap during the surgery.
If you are having open fetal surgery (either in the middle of pregnancy or at delivery), you will then be given medicine to induce general anesthesia.
Once you are asleep, a breathing tube will be placed in your windpipe, a catheter will be placed in your bladder to measure your urine, and a special blood pressure monitor (an arterial line) will be placed in an artery (usually in the wrist). This equipment allows us to monitor your oxygen and carbon dioxide levels, fluid or hydration status, and blood pressure, at all times in order to keep you and your baby as safe as possible during surgery.
After Surgery
After surgery, you will awaken in the operating room. If a breathing tube was used, it will be removed before you are fully awake. The arterial catheter and epidural catheter may be removed in the operating room as well.
As you wake up more fully, you will be moved to a recovery area where specialized nurses will be with you until you are completely awake. Your family will be able to visit with you when you wake up, and your surgeon will talk with you about how the procedure went.
If you had an EXIT procedure, your new baby will most likely be transported directly to the Regional Center for Newborn Intensive Care. A breathing tube will be used for a period of time after delivery to assist your baby's breathing, and medicines will be given through an intravenous catheter as needed. This care will be coordinated by neonatologists, who are pediatricians specialized in the care of newborn babies that are in an intensive care unit.
Rev. 1/07
