Maternal and Fetal Cardiovascular and Acid–Base Changes during Halothane and Isoflurane Anesthesia in the Pregnant Ewe

Palahniuk, Richard J.; Shnider, Sol M.

doi:10.1097/00000542-197411000-00010

Cited by 121 publications

(53 citation statements)

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“…Previous studies have shown that fetal acidosis from inhalational anesthetic agents or impaired uterine blood flow was reversible within 2-24 h. 16,20 With more than a 40-h washout interval, we found no differences between the first and the second experiments in baseline hemodynamic and physiologic parameters, including fetal hematocrit. However, two fetal cardiac arrests with HD-DES exposure occurred during the second experiment.…”

Section: Strength and Limitations Of This Studycontrasting

confidence: 41%

“…19 Previous studies in both midgestational and near-term pregnant ewes showed that high-dose (1.5-2 MAC) halothane, isoflurane, and sevoflurane decreased maternal blood pressure, cardiac output, and uterine blood flow. 5,[20][21][22] This high concentration of inhalational agents also induced reversible fetal hypoxemia and acidosis because of poor uteroplacental perfusion. In our midgestational sheep model, desflurane decreased maternal blood pressure, decreased uterine blood flow, and induced fetal acidosis and fetal cardiac arrest in a dose-dependent fashion.…”

Section: Discussionmentioning

confidence: 99%

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Anesthetic Techniques for Fetal Surgery

et al. 2013

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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. 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. 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. 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. WItH advances in prenatal diagnosis and improvements in fetal surgical techniques, fetal surgery has become an accepted alternative treatment option for certain fetal diseases. This was most recently exemplified by the Management of Myelomeningocele Study, a multicenter randomized trial that demonstrated a reduced need

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Section: Strength and Limitations Of This Studycontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Anesthetic Techniques for Fetal Surgery

et al. 2013

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“…At these levels, maternal CO can drop, with diminution in uterine blood flow of up to 30%. 24 Diminished uterine blood flow results in decreased oxygen delivery to the utero-placental unit and subsequent fetal hypoxia. 25 In the acutely instrumented fetal sheep, halothane has been shown to increase placental and total vascular resistance, potentially limiting gas exchange and adding undue afterload on the fetal heart.…”

Section: Discussionmentioning

confidence: 99%

Acute Cardiovascular Effects of Fetal Surgery in the Human

et al. 2004

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Background-Prenatal surgery for congenital anomalies can prevent fetal demise or alter the course of organ development, resulting in a more favorable condition at birth. The indications for fetal surgery continue to expand, yet little is known about the acute sequelae of fetal surgery on the human cardiovascular system. Methods and Results-Echocardiography was used to evaluate the heart before, during, and early after fetal surgery for congenital anomalies, including repair of myelomeningocele (MMC, nϭ51), resection of intrathoracic masses (ITM, nϭ15), tracheal occlusion for congenital diaphragmatic hernia (CDH, nϭ13), and resection of sacrococcygeal teratoma (SCT, nϭ4). Fetuses with MMC all had normal cardiovascular systems entering into fetal surgery, whereas those with ITM, CDH, and SCT all exhibited secondary cardiovascular sequelae of the anomaly present. At fetal surgery, heart rate increased acutely, and combined cardiac output diminished at the time of fetal incision for all groups including those with MMC, which suggests diminished stroke volume. Ventricular dysfunction and valvular dysfunction were identified in all groups, as was acute constriction of the ductus arteriosus. Fetuses with ITM and SCT had the most significant changes at surgery. Conclusions-Acute cardiovascular changes take place during fetal surgery that are likely a consequence of the physiology of the anomaly and the general effects of surgical stress, tocolytic agents, and anesthesia. Echocardiographic monitoring during fetal surgery is an important adjunct in the management of these patients.

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“…Concentrations higher than 2 MAC of halogenated anesthetics are associated to the development of maternal arterial hypotension, uterine flow reduction, hypoxia and fetal acidosis 32 . In both cases, the uterine relaxation obtained with 2% isoflurane was satisfactory for the whole procedure, without maternal arterial hypotension.…”

Section: Discussionmentioning

confidence: 99%

Anestesia para tratamento intraparto extraútero (EXIT) em fetos com diagnóstico pré-natal de malformações cervical e oral: relato de casos

Helfer¹,

Clivatti

Yamashita³

et al. 2012

Rev. Bras. Anestesiol.

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Helfer DC, Clivatti J, Yamashita AM, Moron AF -Anesthesia for Ex Utero Intrapartum Treatment (EXIT procedure) in Fetus with Prenatal Diagnosis of Oral and Cervical Malformations: Case Reports. Background and objectives:Fetus prenatally diagnosed with neck tumors, or with any other disease that obstructs the airways, should not be treated conventionally, as the assistant physician has to face two challenges right after the infant's delivery: the limited time to establish the access to the potentially difficult airways and the lack of anesthesia of the neonate in case of instrumentation of the airways. The ex utero intrapartum treatment, i.e., the EXIT procedure consists of maintaining the fetoplacental circulation during the cesarean section, until the airways of the fetus be secured.

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Maternal and Fetal Cardiovascular and Acid–Base Changes during Halothane and Isoflurane Anesthesia in the Pregnant Ewe

Cited by 121 publications

References 0 publications

Anesthetic Techniques for Fetal Surgery

Anesthetic Techniques for Fetal Surgery

Acute Cardiovascular Effects of Fetal Surgery in the Human

Anestesia para tratamento intraparto extraútero (EXIT) em fetos com diagnóstico pré-natal de malformações cervical e oral: relato de casos

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