Anesthesia For Maternal – Fetal Surgery

Öz

Fetal surgery is performed on pregnant patient and fetal patient and could be called maternal-fetal surgery. Surgery is on the pregnant women for fetal benefit and anesthesia is necessary for these two patients whose physilogic characteristics are extremly different. Providing anesthesia for fetal surgery necessitates integration of obstetric and pediatric anesthesia integration and many disciplines colloboration and cooperation. The researches are going on about the possibility of anesthetic drugs neurotoxicity on developing nervous system of fetus. The fetus reacts to painfull stimuli and these painfull interventions may cause long term effects . Fetal surgery issues are, minimally invazive interventions, open midgestation surgery and EXIT procedures. An anesthetic plan can range from local anesthetic infiltration to sedation to neuroaxial or general anesthesia. Surgical technique, risk and benefit ratio and potential need are important for optimal anesthetic plan.In this article, we reviewed the maternal physiology, fetal physiology, ethic issues, anesthetics effects on the fetus, anesthetic managements for different types of surgical techniques.

Anahtar Kelimeler

• Fetal surgery,anesthesia

Maternal-Fetal Cerrahide Anestezi Uygulamaları

Öz

Fetal cerrahi anne ve fetal hastayı ilgilendirdiği için fetal-maternal cerrahi olarak adlandırılabilir. Fetusun tedavisi için fizyolojik özellikleri birbirinden farklı iki hastaya anestezi uygulanmaktadır. Fetal cerrahide anestezi uygulamaları doğum ve pediatrik anestezi eğitimi ile farklı disiplinlerin beraber çalışmasını gerektirir. Anestezik ajanların gelişen beyin dokusuna nörotoksik etkileri üzerine ileri araştırmalar devam etmektedir. Ağrılı uyaranlara bağlı olarak fetusun gelişen sinir sistemindeki değişikliklerin uzun dönem etkileri olduğu bilinmektedir. Fetal cerrahi işlemler midgestasyon intrapartum cerrahiler, minimal invaziv girişimler, ve ex utero intrapartum tedaviler EXIT olmak üzere üç grupta toplanır. Anestezi teknikleri, lokal anestezi ve sedasyondan, genel anestezi ve nöroaksiyel anesteziye kadar değişebilir. Cerrahi teknik, anne fetus için risk fayda dengesi, ve önceliklş gereksinimler optimal anestezi planının yapılmasında önemlidir.Bu derlemede; gebedeki fizyolojik değişikliler, fetusun anestezi açısından fizyolojik özellikleri, etik konular, anestezinin fetusa etkileri, cerrahi tekniklere göre anestezi ugulamaları gözden geçirilecektir.

Anahtar Kelimeler

• Fetal cerrahi,anestezi

Kaynakça

1. Lin EE, Tran KM. Anesthesia for fetalsurgery. Semin Pediatr Surg 2013; 22:50–5.
2. Sviggum HP, Kodali BS. Maternal Anesthesia for Fetal Surgery. Clin Peri- natol 2013; 40:413–27.
3. Graves C,Harrison MR,Padilla BE. Minimally invazive fetal surgery. Clin Perinatol 2017;44:729-51.
4. Tran KM, Johnson MP, Almeida-Chen GM, Schwartz AJ. The Fetus as Patient Anesthesiology 2010; 113:462.
5. Ngamprasertwong P, Vinks AA, Anne Boat. Update in fetal anesthesia for the ex utero intrapartum treatment (EXIT) procedure. Int Anesthesiol Clin. 2012; 50: 26–40. 6- Velde MV, Buck F. Fetal and Maternal Analgesia/ Anesthesia for Fetal Procedures. Fetal Diagn Ther 2012;31:201-9.
6. Gupta R, Kilby M,Cooper G. Fetal surgery and anaesthetic implications. Crit Care Pain 2008; 871-5.
7. Chervenak FA, McCullough LB. The ethics of maternal-fetal surgery. Se- min Fetal Neonatal Med 2017;1-4.
8. Kitagawa H, Pringle KC. Fetal surgery: a critical review. Pediatr Surg Int 2017; 33:421–33.

9. Moon-Gady AJ, Baschat A, Cass D, Choolani M, Copel JA, Cromblehol- me TM et al. Fetal treatment 2017: The evollution of fetal theraphy cen- ters-A joint opinion from the International Fetal Medicine and Surgical So- ciety (IFMSS) and the North American Fetal Therapy Network (NAFTNet). Fetal Diagn Ther 2017; 42:241-8.
10. Buck F, Deprest J,Velde MV. Anesthesia for fetal surgery. Curr Opin Ana- esthesiol 2008; 21:293-7.
11. Ngamprasertwong P, Habli M, Boat A, Lim FY, Esslinger H, Ding L ,Sa- dhasivam S. Maternal hypotension during fetoscopic surgery: Incidense and its impact on fetal survival outcomes. ScientificWorldJournal 2013; 709059.
12. Brusseau R, Mizrahi-Arnaud A. Fetal anesthesia and pain management for intrauterine therapy. Clin Perinatol 2013; 40:429-42.
13. Boat A, Mahmoud M, Michelfelder EC, Lin E, Ngamprasertwong P, Sch- nell B et al. Supplementing desflurane with intravenous anesthesia re- duces fetal cardiac dysfunction during open fetal surgery. Paediatr Ana- esth. 2010; 20:748-56.
14. Boat AC, Sadhasivam S, Loepke AW, Kurth CD. Outcome for the extre- mely premature neonate: how far do we push the edge? Paediatr Ana- esth. 2011; 21:765-70.
15. Oliveira E, Pereira P, Retroz C, Martires E. Anesthesia for EXIT procedure (Ex utero intrapartum treatment) in congenital cervical malformation-a challenge to the anesthesiologist. Rev Bras Anestesiol 2015;65:529-33.
16. McPherson C, Inder T. Perinatal and neonatal use of sedation and analge- sia. Semin Fatal Neonatal Med 2017;22:314-20.
17. Laje P, Johnson MP, Howell LJ, Bebbington MW, Hedrick HL, Flake AW et al. Ex utero intrapartum treatment in the management of giant cervical teratomas. J Pediaatr Surg. 2012:47:1208-16.
18. Ngamprasertwong P, Michelfleder EC, Arbabi S, Choi YS, Statile C, Ding L, Boat A, Eghtesady P, Holland K, Sadhasivam S. Anesthetic techniques for fetal surgery. Effects of maternal anesthesia on intraoperative fetal outcomes in a sheep model. Anesthesiology 2013; 118:796-808.