Application of Near-Infrared Spectroscopy During Fetal Cardiac Surgery

Reed, Casey A.; Baker, Richard S.; Lam, Christopher T.; Hilshorst, Jerri L.; Ferguson, Robert; Lombardi, John; Eghtesady, Pirooz

doi:10.1016/j.jss.2009.11.012

Cited by 10 publications

(6 citation statements)

References 25 publications

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“…These parameters are also useful for fetal assistance. Likewise, Reed et al [17] analyzed the hemodynamic parameters via fetal umbilical venous puncture. All the techniques mentioned are of great value but nonetheless present high risks when performed in humans.…”

Section: Discussionmentioning

confidence: 99%

Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

Santana¹,

Moron²,

Barbosa³

et al. 2015

Fetal Diagn Ther

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Objective: The aim of this study was to assess fetal hemodynamics during intrauterine open surgery for myelomeningocele (MMC) repair by describing fetal heart rate (FHR) monitoring in detail related to each part of the procedure. Methods: A study was performed with 57 fetuses submitted to intrauterine MMC repair between the 24th and 27th week of gestation. Evaluations of FHR were made in specific periods: before anesthesia, after anesthesia, at the beginning of laparotomy, during uterus abdominal withdrawal, hysterotomy, neurosurgery (before incision, during early skin manipulation, spinal cord releasing, and at the end of neurosurgery), abdominal cavity reintroduction, and abdominal closure, and at the end of surgery. Means ± standard deviations of FHR were established for each period, and analysis of variance with repeated measures was used to assess differences between these periods. The mean differences were assessed with 95% confidence intervals and were analyzed by Tukey's multiple comparison test. Results: The mean FHR during the specific periods mentioned above was 140.2, 140, 139.2, 138.8, 135.1, 133.9, 123.1, 134.0, 134.5, 137.9, and 139.9 bpm, respectively (p < 0.0001). Comparing the different periods, the highest frequencies were observed in the initial and final moments. The neurosurgery stage presents lower frequencies, especially during the release of the spinal cord. Conclusion: FHR monitoring revealed interesting findings in terms of physiological fetal changes during MMC repair, especially during neurosurgery, which was the most critical period.

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Section: Discussionmentioning

confidence: 99%

Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

Santana¹,

Moron²,

Barbosa³

et al. 2015

Fetal Diagn Ther

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“…NIRS has been used in adult, pediatric and neonatal populations to assess cerebral oxygenation as well as somatic organ perfusion 40,41 . In fetal cardiac surgery animal models, NIRS correlated well with the umbilical venous oxygenation 42 . The use of NIRS during fetal surgery has not been reported, but it may prove valuable to monitor fetal well-being during the EXIT procedure.…”

Section: Introductionmentioning

confidence: 82%

Update in Fetal Anesthesia for the Ex Utero Intrapartum Treatment (EXIT) Procedure

Ngamprasertwong

Vinks

Boat

2012

International Anesthesiology Clinics

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The ex-utero intrapartum treatment (EXIT) is one type of fetal surgery, performed before delivery while the fetus remains attached to the uteroplacental circulation. This intervention improves neonatal morbidity and mortality of certain congenital diseases. For instance, securing the airway of a fetus with congenital airway obstruction while on uteroplacental circulation prevents the hypoxemia during the establishment of an airway post-delivery. Anesthesia for fetal surgery now incorporates new knowledge of the maternal/fetal response to anesthetic agents. This chapter reviews for the EXIT procedure the effects of maternal anesthesia on fetal hemodynamics, intravenous anesthesia to supplement inhalational anesthesia in order to provide maternal-fetal hemodynamic stability during surgery, intraoperative fetal monitoring, maternal pharmacokinetics approach to study placental drug transfer and fetal pharmacokinetics to improve our understanding of the effects of maternal anesthesia on the fetus.

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“…Routinemäßig wurde NIRS in der Erwachsenen-, pädiatrischen und neonatalen Chirurgie zur Erfassung der Oxygenierung des Gehirns und anderer Organe eingesetzt [25]. Im fetalen herzchirurgischen Tiermodell korrelierte NIRS gut mit der umbilikalvenösen Sättigung [26], allerdings ist NIRS noch nicht in der humanen fetalen Chirurgie eingesetzt worden.…”

Section: Nirsunclassified

Geburtshilfe: Anästhesie bei EXIT-Prozedur

Torossian¹

2017

Anästhesiol Intensivmed Notfallmed Schmerzther

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The ex utero intrapartum treatment (EXIT) procedure is performed as a part of an extended caesarean section for example to treat fetal airway disorders. For treatment, optimal uterine relaxation is necessary, however utero-placental supply of the fetus has to be guaranteed as well. "Balanced" anesthesia, tocolysis and tight maternal arterial blood pressure control are recommended. Standard fetal monitoring comprises pulse oxymetry and echocardiography. The article describes the physiology and anesthestic goals of the EXIT procedure, discusses alternative anesthesia techniques and gives an outlook on emerging progress.

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Application of Near-Infrared Spectroscopy During Fetal Cardiac Surgery

Cited by 10 publications

References 25 publications

Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

Update in Fetal Anesthesia for the Ex Utero Intrapartum Treatment (EXIT) Procedure

Geburtshilfe: Anästhesie bei EXIT-Prozedur

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