Effect of Direct Fetal Opioid Analgesia on Fetal Hormonal and Hemodynamic Stress Response to Intrauterine Needling

Fisk, Nicholas M.; Gitau, Rachel; Teixeira, Jerónima; Giannakoulopoulos, Xenophon; Cameron, Alan; Glover, Vivette

doi:10.1097/00000542-200110000-00008

Cited by 163 publications

(74 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…47,48 These stress responses are largely mediated in the spinal cord, brain stem, or basal ganglia, rather than the cortex. Although, they are blunted by opioid administration 40 , reduction of stress hormones are not necessarily indicative of adequate analgesia. 49 Moreover, these stress responses are different than the multidimensional, subjective phenomenon that we experience as pain.…”

Section: Fetal Analgesia and Anesthesiamentioning

confidence: 99%

See 1 more Smart Citation

Anesthesia for In Utero Repair of Myelomeningocele

Ferschl

Ball

Lee

et al. 2014

Survey of Anesthesiology

View full text Add to dashboard Cite

Recently published results suggest that prenatal repair of fetal myelomeningocele is a potentially preferable alternative when compared to postnatal repair. In this article, the pathology of myelomeningocele, unique physiologic considerations, perioperative anesthetic management, and ethical considerations of open fetal surgery for prenatal myelomeningocele repair are discussed. Open fetal surgeries have many unique anesthetic issues such as inducing profound uterine relaxation, vigilance for maternal or fetal blood loss, fetal monitoring, and possible fetal resuscitation. Postoperative management, including the requirement for postoperative tocolysis and maternal analgesia are also reviewed. The success of intrauterine myelomeningocele repair relies on a well-coordinated multidisciplinary approach. Fetal surgery is an important topic for anesthesiologists to understand, as the number of fetal procedures is likely to increase as new fetal treatment centers are opened across the United States.

show abstract

Section: Fetal Analgesia and Anesthesiamentioning

confidence: 99%

“…Invasive fetal procedures clearly elicit a stress response 40 , but it is unclear if this response correlates with conscious perception of pain. By 19 weeks gestational age, a fetus can reflexively withdraw from a noxious stimulus without involvement of the cerebral cortex.…”

Section: Fetal Analgesia and Anesthesiamentioning

confidence: 99%

Anesthesia for In Utero Repair of Myelomeningocele

Ferschl

Ball

Lee

et al. 2014

Survey of Anesthesiology

View full text Add to dashboard Cite

show abstract

“…Pretreatment of the fetus with fentanyl for this same procedure attenuated the rise in ß-endorphin. 48 Hormonal stress responses do not provide a direct index of pain. While it is true that a rise in cortisol and endorphin is seen as a consequence of painful stimuli in children, other non-painful situations (for example, exercise) are also associated with an increase in the levels of these hormones.…”

Section: Static Charge-sensitive Bed (Scsb)mentioning

confidence: 99%

“…Fentanyl, in relatively large doses (12.5-25 µg·kg -1 estimated fetal weight), attenuates the autonomic and hormonal stress response during potentially painful procedures. 48,151 In the face of intense uterine tocolysis, maintenance of maternal blood pressure may require concomitant vasopressor therapy.…”

Section: Fetal Surgerymentioning

confidence: 99%

See 1 more Smart Citation

Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Littleford

2004

Can J Anesth/J Can Anesth

118

View full text Add to dashboard Cite

P Pu ur rp po os se e: : To review the effects of maternal anesthesia and analgesia on the fetus and newborn.M Me et th ho od ds s: : An on-line computerized search of Medline, Embase, and the Cochrane Collaboration via PubMed was conducted. English language articles were selected. The bibliographies of relevant articles and additional material from other published sources were retrieved and reviewed.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : No one test clearly separates the effects on the fetus/newborn, if any, of maternally administered medication during labour and delivery, or during surgery for non-obstetric indications. Supposition in this regard is limited in part by methodology previously used to study the transplacental passage of various drugs. This work needs to be repeated using a human model. Routine maternal supplemental oxygen administration is being questioned in light of research showing that free radical generation and oxidative stress are implicated as the underlying mechanisms in several neonatal conditions. Maternal hypotension is associated with neonatal acidemia and base excess correlates with neonatal outcome. Common postpartum analgesics transfer minimally into breast milk. Maternal or fetal surgery conducted during pregnancy necessitates modification of both anesthetic and surgical approaches. The key to resuscitation of the fetus is resuscitation of the mother: intra-uterine maneuvers, including perimortem Cesarean section, aim to reverse treatable causes of fetal asphyxia, restore fetal oxygenation, and correct fetal acidosis.C Co on nc cl lu us si io on ns s: : The well-being of the infant is a major criterion for evaluating the anesthetic management of pregnant women. Many tools exist to assist with this determination for the fetus, whereas few are available to evaluate the newborn. Méthode : Une recherche informatisée en ligne des bases Medline et Embase et du Centre de collaboration Cochrane via PubMed a été réalisée. Des articles de langue anglaise ont été sélectionnés. Les bibliographies d'articles pertinents et du matériel additionnel d'autres publications ont été retenus et passés en revue. Constatations principales : Aucun test ne sépare clairement les effets sur le foetus/nouveau-né, si effet il y a, des médicaments administrés à la mère pendant le travail et l'accouchement ou pendant une intervention chirurgicale non obstétricale. Les hypothèses possibles

show abstract