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AANA June 2025 Journal Course : Anesthetic Conside ...
Anesthetic Considerations for Maternal-Fetal Inter ...
Anesthetic Considerations for Maternal-Fetal Interventions
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Pdf Summary
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
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