Anesthesia for fetal minimal access surgery

Fetal surgery, whether minimal access or not, involves intervention on two patients. Issues of maternal safety, teratogenicity of anesthetic agents, fetal asphyxia and monitoring, and uterine relaxation must be addressed for optimal outcomes. Prevention of preterm labor remains a major challenge and should be started before leaving the operating room. Surgical approach, i.e. whether a laparotomy is required to achieve adequate access to the fetus, will guide the anesthesiologist in the choice of anesthetic plan. Fetal anesthesia needs to be considered for those procedures that involve direct intervention on the fetus, as opposed to placental or umbilical manipulations.