Avoiding the Use of Halogenated Anesthetic Agents for Uterine Relaxation in Open Mid-Gestation Fetal Surgery: A Case Report

Abstract

Introduction: Profound uterine relaxation is required for open fetal surgery. This is typically achieved by the administration of high-dose halogenated anesthetic agents. However, this anesthetic technique is associated with adverse cardiovascular effects in the fetus and may have long-term neurocognitive effects as well. Case Presentation: We present reports for two patients in whom uterine relaxation was maintained with nitroglycerin and magnesium infusions without any exposures to halogenated anesthetic agents. There were no adverse fetal or maternal effects from this technique. Discussion/Conclusion: To the best of our knowledge, these are the first reports of open fetal surgery being performed without the use of halogenated anesthetic agents. This has potential short- and long-term benefits for the fetus, particularly as more complex and longer duration minimally invasive procedures are developed.