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Anesthetic techniques for fetal surgery: effects of maternal anesthesia on intraoperative fetal outcomes in a sheep model.
- Source :
-
Anesthesiology [Anesthesiology] 2013 Apr; Vol. 118 (4), pp. 796-808. - Publication Year :
- 2013
-
Abstract
- Background: Use of high-dose inhalational anesthesia during open fetal surgery may induce maternal-fetal hemodynamic instability and fetal myocardial depression. The authors' preliminary human retrospective study demonstrated less fetal bradycardia and left ventricular systolic dysfunction with lower dose desflurane supplemented with propofol and remifentanil IV anesthesia (SIVA). In this animal study, the authors compare maternal-fetal effects of high-dose desflurane anesthesia (HD-DES) and SIVA.<br />Methods: Of 26 instrumented midgestational ewes, data from 11 animals exposed to both SIVA and HD-DES in random sequences and six animals exposed to HD-DES while maternal normotension was maintained were analyzed. Maternal electroencephalography was used to guide comparable depths of anesthesia in both techniques. Hemodynamic parameters, blood gas, and fetal cardiac function from echocardiography were recorded.<br />Results: Compared with SIVA, HD-DES resulted in significant maternal hypotension (mean arterial pressure difference, 19.53 mmHg; 95% CI, 17.6-21.4; P < 0.0001), fetal acidosis (pH 7.11 vs. 7.24 at 150 min, P < 0.001), and decreased uterine blood flow. In the HD-DES group with maternal normotension, uterine blood flow still declined and fetal acidosis persisted, with no statistically significant difference from the group exposed to HD-DES that had maternal hypotension. There was no statistically significant difference in fetal cardiac function.<br />Conclusion: In sheep, SIVA affects maternal hemodynamics less and provides better fetal acid/base status than high-dose desflurane. Fetal echocardiography did not reflect myocardial dysfunction in this model.
- Subjects :
- Acid-Base Equilibrium drug effects
Acidosis chemically induced
Anesthetics, Combined pharmacology
Animals
Arterial Pressure drug effects
Blood Pressure drug effects
Cross-Over Studies
Desflurane
Electroencephalography methods
Female
Fetus
Isoflurane analogs & derivatives
Isoflurane pharmacology
Monitoring, Intraoperative methods
Piperidines pharmacology
Pregnancy
Propofol pharmacology
Regional Blood Flow drug effects
Remifentanil
Sheep
Uterus blood supply
Anesthesia, Obstetrical methods
Anesthetics, Inhalation pharmacology
Anesthetics, Intravenous pharmacology
Heart Rate, Fetal drug effects
Intraoperative Complications chemically induced
Uterus drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1175
- Volume :
- 118
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Anesthesiology
- Publication Type :
- Academic Journal
- Accession number :
- 23343650
- Full Text :
- https://doi.org/10.1097/ALN.0b013e318283c954