AANA June 2025 Journal Course : Anesthetic Considerations for Maternal-Fetal Interventions-Anesthetic Considerations for Maternal-Fetal Interventions

Anesthetic Considerations for Maternal-Fetal Interventions

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The document discusses the crucial role of anesthetic management in maternal-fetal surgery (MFS), a field that emerged following advances in fetal imaging and prenatal diagnoses. This specialized surgical practice includes minimally invasive, open, and ex utero intrapartum treatment (EXIT) procedures. Each type has distinct anesthetic needs. Certified Registered Nurse Anesthetists (CRNAs) must be familiar with these because MFS is rapidly evolving. Understanding factors such as physiologic changes in pregnancy and fetal physiology is vital to ensure effective anesthesia, maintain uteroplacental blood flow, and minimize risks associated with general anesthesia.<br /><br />The history and evolution of MFS are explored, highlighting milestones like the first fetal surgery in 1981 and pivotal clinical trials that advanced the practice. The document outlines the ethical considerations and policy implications, urging CRNAs to recognize legal definitions and respect maternal consent.<br /><br />Key anesthetic considerations involve maintaining maternal hemodynamics, ensuring fetal analgesia and immobility during procedures, and managing drug transfer across the placenta. It emphasizes tailored approaches for different MFS types, such as general anesthesia for open and EXIT surgeries, which require profound uterine relaxation to facilitate surgical access and prevent fetal hypoxia.<br /><br />CRNAs are advised to prepare for emergencies, including maternal cardiac arrest and fetal resuscitation. The guidance includes preoperative planning, monitoring requirements, medication dosing, positions to prevent aortocaval compression, and strategies to maintain uterine relaxation and fetal stability.<br /><br />Overall, CRNAs play an essential role in supporting both the mother and fetus through these complex surgeries, ensuring safe outcomes by adapting to the nuanced requirements of anesthetic care in MFS.

Keywords

anesthetic management

maternal-fetal surgery

fetal imaging

prenatal diagnoses

Certified Registered Nurse Anesthetists

uteroplacental blood flow

fetal physiology

ethical considerations

maternal consent

fetal resuscitation