Anesthetic practices and physiological foundations in fetal surgery: a literature review

Fetal anesthesia plays a critical role in ensuring maternal and fetal safety and optimizing outcomes during fetal surgical interventions. Despite its importance, there is currently no consensus regarding optimal anesthetic strategies for these procedures. This narrative review explores the principal types of fetal surgery, including minimally invasive and fetoscopic procedures, open fetal surgery, and Ex Utero Intrapartum Treatment, with particular emphasis on the factors influencing anesthetic decision-making. A comprehensive literature search was conducted across SciELO, PubMed, and Google Scholar, including articles published in any language up to May 2024. This review aims to highlight current anesthetic techniques and relevant maternal-fetal physiological considerations. Although fetal surgery can be performed safely using different anesthetic modalities, anesthetic management should be individualized according to maternal and fetal conditions, patient preferences, and the expertise of the multidisciplinary team. The lack of standardized guidelines and the limited availability of high-quality evidence underscore the need for further research. Future studies should focus on protocol development, complication management, and the use of adjuvant therapies to enhance maternal and fetal outcomes.