• Olivia Nelson, Allan F Simpao, Kha M Tran, and Elaina E Lin.
• Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia.
• Curr Opin Anaesthesiol. 2020 Jun 1; 33 (3): 368-373.

Purpose Of ReviewThis review describes maternal and fetal anesthetic management for noncardiac fetal surgical procedures, including the management of lower urinary tract obstruction, congenital diaphragmatic hernia (CDH), myelomeningocele, sacrococcygeal teratoma, prenatally anticipated difficult airway and congenital lung lesions.Recent FindingsFetal interventions range from minimally invasive fetoscopic procedures to mid-gestation open surgery, to ex-utero intrapartum treatment procedure. Anesthetic management depends on the fetal intervention and patient characteristics. Anesthesia for most minimally invasive procedures can consist of intravenous sedation and local anesthetic infiltration in clinically appropriate maternal patients. Open fetal and ex-utero intrapartum treatment procedures require maternal general anesthesia with volatile anesthetic and other medications to maintain uterine relaxation. Tracheal balloons are a promising therapy for CDH and can be inserted via minimally invasive techniques. Management of the prenatally anticipated difficult airway during delivery and removal of tracheal balloons from patients with CDH during delivery can be clinically dynamic and require flexibility, seamless communication and a high-functioning, multidisciplinary care team.SummaryMaternal and fetal anesthetic management is tailored to the fetal intervention and the underlying health of the fetus and mother.

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