Protocolo de anestesia para cirugía de cierre abierto de mielomeningocele in-utero: una serie de casos

Abstract

Myelomeningocele (MMC) is a subtype of spina bifida, occurs due to a neural tube closure defect during embryogenesis, is usually compatible with life and is associated in most cases with Arnold Chiari malformation. In Colombia, it is estimated that there are 1.41 cases per 10,000 bir - ths. Currently, the gold standard for the treatment of this malformation is prenatal surgical closure before the 26th week of gestation. To carry out this procedure, special anesthetic techniques are required to guarantee safety, analgesia, immobility, neuromuscular relaxation, and fetal-maternal well-being in the perioperative period. In our institution we developed an anesthetic protocol which we applied in 8 cases of prenatal myelomeningocele closure performed in the period between 2020 and 2022, the mean age of the participants was 31.8 years, all of them had an ASA classification. II; the mean duration of anesthesia was 3 h 50 min and approximately 11.97 mcg/kg/h of norepinephrine was administered in each procedure. Said protocol was effective in 100% of the cases, it avoided complications and improved maternal-fetal perioperative outcomes, likewise, it achieved the analgesic objectives, neuromuscular relaxation, hemodynamic stability, without maternal-fetal adverse effects, for this reason we suggest implementing it to carry out this study. types of fetal procedures safely and effectively.