Fetal Surgery...Part I

In 1963 Sir William Liley performed the first successful fetal procedure, consisting of an intraperitoneal blood transfusion.

In the past two decades, fetal surgery has become popularized in the management of congenital anomalies that may lead to complication at delivery.

Fetal surgical procedures can be divided into:

1.Minimally invasive intervention.

These are the most frequently performed fetal surgical procedure. The access may be as minor as one small gauge radio frequency probe; the timing of these procedures is early or mid-gestation.

2. Open mid-gestation surgery.

A maternal laporotomy is performed; the incision is usually transverse and cephalic than that performed in c/section, the necessary anatomy of the fetus is only delivered via the hysterotomy.

3. EX-utero intrapartum therapy (EXIT) procedure.

These procedures are performed at or near term to optimize lung maturity. Surgical intervention is performed before the umbilical cord is clamped while on placental bypass.

The next part will include the anesthetic plan in fetal surgical cases.

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The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by: the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by: the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

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