Fetoscopic insufflation of heated‐humidified carbon dioxide during simulated spina bifida repair is safe under controlled anesthesia in the fetal lamb

Joyeux, Luc; Basurto, David; Bleeser, Tom; Veeken, Lennart Van der; Vergote, Simen; Kunpalin, Yada; Trigo, L.; Corno, E.; Bie, Felix De; Coppi, Paolo De; Ourselin, Sébastien; Calenbergh, Frank Van; Hooper, Stuart B.; Rex, Steffen; Deprest, Jan

doi:10.1002/pd.6093

Cited by 3 publications

(1 citation statement)

References 59 publications

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“…However, recent publications suggest that the risk of PROM does not seem to be increased with a fetoscopic approach compared to open surgery, although an anterior location of the placenta has been suggested to be a risk factor [19]. Following previous reports, we used humidified and heated CO 2 to prevent the desiccation of the membranes and avoid fetal acidosis and hypercapnia [22]; the benefit of these refinements on the reduction of PROM remains to be demonstrated and fully understood.…”

Section: Discussionmentioning

confidence: 99%

Laparotomy-Assisted 2-Port Fetoscopic Repair of Spina Bifida Aperta: Report of a Single-Center Experience in Paris, France

et al. 2022

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Background: Given the maternal morbidity of open fetal surgery, the development of prenatal fetoscopic repair for spina bifida aperta (SBA) is encouraged. Objective: We hereby report the early results from our center, using a laparotomy-assisted CO2-fetoscopic approach. Methods: This study was conducted in patients with an SBA<T1 and >S1, <26 weeks’ of gestation, with Chiari II. Fetoscopic repair was performed using 2 operating trocars in the uterus exteriorized through a transverse laparotomy. Endoscopy was performed under humidified and heated CO2 insufflation. Following dissection of the lesion, a 1-layer approach was performed with a muscle/skin flap sutured over a patch of Duragen. Main outcomes were watertight repair at birth and the need for postnatal neurosurgical surgery including shunting within 6 months. Results: Of 87 women assessed for prenatal therapy, 7 were included. Surgery was performed at 24 (23-26) weeks’ gestation. There was no fetal demise. Conversion to hysterotomy was not performed, although surgery could not be performed in one case because of fetal position. Severe preeclampsia developed postoperatively in one case. In the other 6 cases, follow-up was uneventful except for premature rupture membranes which occurred in 3/6 cases at 30, 34 and 36+5-weeks’ gestation. Gestational age at delivery was 32+5 (31-36+5) weeks’ gestation. Repair was watertight at birth except in two cases which required complementary postnatal surgical repair. Reverse hindbrain herniation during pregnancy was observed in 4/6 cases. In 3/6 cases, shunting was necessary within six months after birth. At 12 months, a functional gain >= 2 metameric levels, was observed in 3 cases of the 6 survivors Conclusion: Laparotomy-assisted fetoscopic repair is a reasonable option for women who choose and are eligible for antenatal surgery, both in terms of maternal and perinatal morbidity.

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Section: Discussionmentioning

confidence: 99%

Laparotomy-Assisted 2-Port Fetoscopic Repair of Spina Bifida Aperta: Report of a Single-Center Experience in Paris, France

et al. 2022

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Haemodynamic variables and arterial blood gas values in conscious pregnant sheep: A pilot study

Bleeser,

Vergote,

Basurto

et al. 2024

Veterinary Anaesthesia and Analgesia

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Optimal Maternal Ventilation During Laparotomy with General Anesthesia in Pregnancy in the Ovine Model

Bleeser,

Joyeux,

Vergote

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: General anesthesia during pregnancy is not uncommon, for example, for trauma surgery, cerclage, or cesarean delivery. Current recommendations are to maintain maternal partial pressure of carbon dioxide in arterial blood (paCO2) at 30 mm Hg, which is based solely on the average maternal paCO2 in awake pregnant women. However, there is no evidence that this target, compared to other targets, would enable optimal conditions for the fetus during general anesthesia. Maternal paCO2 can affect uterine blood flow, affinity of hemoglobin for oxygen, and fetal CO2 elimination. In this study, a range of potential targets of maternal paCO2 was investigated in the ovine model, aiming to determine which target is most conducive to physiological fetal blood gas values during laparotomy with general anesthesia. METHODS: Ten time-mated pregnant Swifter ewes with a gestational age of 93 to 104 days were used. During the first phase of the experiment, anesthesia was induced, all ewes were ventilated to target a physiological maternal paCO2 of 30 mm Hg, a maternal laparotomy was performed, and a fetal microcatheter was inserted surgically to enable blood sampling from the fetal aorta. Thereafter, in the second phase of the experiment, the 10 pregnant ewes were randomized to 10 different targets of maternal paCO2 between 27 and 50 mm Hg (1 target for each ewe), and maternal ventilation was adjusted accordingly. Forty-five minutes later, maternal and fetal arterial blood gas samples were analyzed. Linear regression models were used to estimate maternal paCO2 enabling physiologic fetal parameters, including fetal paCO2 (primary outcome). RESULTS: A maternal paCO2 of 27.4 mm Hg (95% confidence interval, 23.1–30.3) enabled physiological fetal paCO2. Each increase in maternal paCO2 by 1 mm Hg, on average, increased fetal paCO2 by 0.94 mm Hg (0.69–1.19). This relationship had a strong correlation (r² = 0.906). No fetuses died during the experiment. CONCLUSIONS: This study provides experimental support for the clinical recommendation to maintain maternal paCO2 close to the physiologic value of 30 mm Hg during general anesthesia for maternal laparotomy in pregnancy as it is conducive to physiological fetal blood gas values. Given the lower bound of the 95% confidence interval, the possibility that a lower maternal paCO2 would improve fetal gas exchange cannot be excluded.

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Fetoscopic insufflation of heated‐humidified carbon dioxide during simulated spina bifida repair is safe under controlled anesthesia in the fetal lamb

Cited by 3 publications

References 59 publications

Laparotomy-Assisted 2-Port Fetoscopic Repair of Spina Bifida Aperta: Report of a Single-Center Experience in Paris, France

Laparotomy-Assisted 2-Port Fetoscopic Repair of Spina Bifida Aperta: Report of a Single-Center Experience in Paris, France

Haemodynamic variables and arterial blood gas values in conscious pregnant sheep: A pilot study

Optimal Maternal Ventilation During Laparotomy with General Anesthesia in Pregnancy in the Ovine Model

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