The first national survey of anesthesia techniques for fetal therapies in Japan

Noguchi, Shohei; Tanaka, Motoshi; Terui, Keita

doi:10.1007/s00540-019-02690-w

Cited by 7 publications

(9 citation statements)

References 11 publications

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“…In the rabbit model, additional administration of fetal injected atropine‐fentanyl‐curare does not lead to measurable short‐term neurocognitive effects. Many centers still rely on general maternal anesthesia to achieve fetal analgesia and immobilization 38 . Based on these findings and our previous findings on maternal anesthesia in the rabbit model, a direct fetal injection with medication would be preferred to achieve fetal analgesia.…”

Section: Discussionmentioning

confidence: 82%

Fetally‐injected drugs for immobilization and analgesia do not modify fetal brain development in a rabbit model

et al. 2021

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Objective During fetal surgery, fetuses receive medication (atropine‐fentanyl‐curare) to prevent fetal pain, movement and bradycardia. Although essential there has been no detailed review of potential side effects. Herein we aimed to assess the effects of this medication cocktail on fetal brain development in a rabbit model. Methods Pregnant does underwent laparotomy at 28 days of gestation. Two pups of each horn were randomized to an ultrasound guided injection with medication (atropine‐cisatracurium‐fentanyl, as clinically used) or saline (sham). The third pup was used as control. At term, does were delivered by cesarean. Outcome measures were neonatal biometry, neuromotoric functioning and neuro‐histology (neuron density, synaptic density and proliferation). Results Maternal vital parameters remained stable during surgery. Fetal heart rates did not differ before and after injection, and were comparable for the three groups. At birth, neonatal body weights and brain‐to‐body weight ratios were also comparable. Both motor and sensory neurobehavioral scores were comparable. There were no differences in neuron density or proliferation. Sham pups, had a lower synaptic density in the hippocampus as compared to the medication group, however there was no difference in the other brain areas. Conclusion In the rabbit model, fetal medication does not appear to lead to short‐term neurocognitive effects.

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Section: Discussionmentioning

confidence: 82%

Fetally‐injected drugs for immobilization and analgesia do not modify fetal brain development in a rabbit model

et al. 2021

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“…Un equipo de 14 anestesiólogos proporcionó la técnica anestésica. Para todas las punciones se realizó asepsia y antisepsia en la región lumbar e infiltración de la piel y el tejido celular subcutáneo con anestésico local sin epinefrina 20 . Para la anestesia epidural se realizó punción lumbar y se ubicó el espacio peridural con técnica de pérdida de resistencia al aire 20 .…”

Section: Materiales Y Métodosunclassified

“…Para todas las punciones se realizó asepsia y antisepsia en la región lumbar e infiltración de la piel y el tejido celular subcutáneo con anestésico local sin epinefrina 20 . Para la anestesia epidural se realizó punción lumbar y se ubicó el espacio peridural con técnica de pérdida de resistencia al aire 20 . Al comprobar aspiración negativa se realizó prueba con bupivacaína con o sin opioide y se insertó catéter en el espacio peridural con aguja 16-18 G 20 .…”

Section: Materiales Y Métodosunclassified

“…Si bien el uso de anestesia general puede asegurar mejores niveles de sedación y analgesia, esta técnica se ha asociado con un mayor consumo de oxígeno y una incidencia más alta de hipotensión materna e hipoxia fetal secundaria 19 - 20 . Al comparar la anestesia general frente a otros abordajes, un estudio observacional evidenció que esta presenta mayor fluctuación de la frecuencia cardiaca y tensión arterial materna, lo que conlleva una mayor tasa de complicaciones 21 .…”

Section: Introductionunclassified

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Seguridad de la anestesia neuroaxial en mujeres con embarazo gemelar y síndrome de transfusión feto-fetal, sometidas a fotocoagulación láser. Estudio de cohorte retrospectiva

Laverde-Martínez

Zamudio-Castilla

Arango

et al. 2021

Rev. Colomb. Obstet. Ginecol.

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Objetivo: describir las características clínicas y la frecuencia de complicaciones maternas, fetales y neonatales, según técnica de anestesia neuroaxial (AN) en mujeres con síndrome de transfusión feto-fetal (STFF) tratadas con fotocoagulación láser (FL). Materiales y métodos: estudio de cohorte retrospectiva descriptivo. Se incluyeron gestantes con STFF tratadas con FL y AN en la Fundación Valle del Lili, Cali (Colombia) entre 2013-2017. Se excluyeron pacientes con STFF estadio-V de Quintero. Se usó estadística descriptiva. El protocolo fue aprobado por el Comité de Ética de la institución. Resultados: 32 participantes cumplieron con los criterios de inclusión y de exclusión. La población estuvo constituida por mujeres jóvenes, multíparas. En el 87,5% de los casos se realizó intervención de urgencia. El 43,7% presentaba el estadio-III de Quintero y en el 56,2 % de las gestantes se utilizó anestesia epidural. Las variables hemodinámicas maternas exhibieron un comportamiento similar, acorde al momento de la cirugía y la técnica neuoraxial implementada. El 65,6 % de las gestantes presentó hipotensión sostenida y el 9,3 % desarrolló edema pulmonar. El 65,6 % de las pacientes experimentó parto pretérmino y el 18,7 % ruptura prematura de membranas. Se registraron 14 muertes fetales y cinco neonatales. No se registraron casos de mortalidad materna. Conclusiones: en pacientes con STFF que requieren FL, el uso de la anestesia epidural, espinal o combinada probablemente se asocia con un comportamiento similar al de las variables hemodinámicas maternas, durante los momentos de la cirugía. Los profesionales que brindan atención a estas gestantes deben estar alerta ante la frecuente aparición de complicaciones maternas, fetales y neonatales. Se requieren estudios que evalúen la seguridad y la efectividad de las diferentes técnicas de anestesia neuroaxial en pacientes con STFF.

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“…Anesthesia for minimally invasive fetal surgical procedures with minimal manipulation including the shunting procedures is generally simple with mild maternal intravenous sedation and/or neuraxial anesthesia (usually epidural or combined spinal-epidural) paired with use of local anesthesia at the skin entry site of the needle or trocar [84][85][86][87]. Certain cases may require fetal immobilization for the procedure which can be achieved through maternal administration of a remifentanil infusion or via direct fetal administration of agents into the fetal leg, typically using an ultrasoundguided fetal intramuscular injection of fentanyl, a neuromuscular agent, and atropine [84].…”

Section: Element Considerations For Intra-percutaneous Ultrasound-guided Fetal Surgery Procedures Managementmentioning

confidence: 99%

Evaluation of the Fetal Therapy Evidence in Lower Urinary Tract Obstruction: Would an ERAS Guideline Improve Outcomes?

Wilson¹,

Nelson²

2021

Fetal Diagn Ther

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Background: Pregnancies that are prenatally identified to have fetal anomalies are complex and require expert multidisciplinary care. As many conditions can impact the fetus prenatally and require intervention, an enhanced recovery after surgery (ERAS) for lower urinary tract obstruction (LUTO) is being evaluated to determine the level of evidenced-based data available. Problem: The percutaneous ultrasound-guided fetal surgery procedure for bladder neck obstruction is the focus for elements of preoperative counseling, intraoperative procedure/risk complications, and postoperative management. Methods: A quality improvement review Squire 2.0 (2000–2020) was undertaken for the percutaneous LUTO fetal surgery shunting (lower urinary tract obstruction), process and procedure which require 2 process pathways, one to evaluate the fetal candidate and a second to treat. This structured review is focused on identifying the process elements to allow the determination of the number of evidenced-based elements that would allow for audit and measurement of the clinical element variance for comparative feedback to the individual surgical provider or surgery center. Interventions: Titles and abstracts were screened to identify potentially relevant articles with priority given to meta-analyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series. Results: A series of potential clinical elements for the diagnostic fetal evaluation and for the 3 protocol areas of surgical care for the procedures (pre-, intra-, and postoperative care) are identified using an ERAS-like process. Conclusions: The identified clinical elements have the potential for ERAS-LUTO fetal therapy guideline. Multidisciplinary collaboration (surgeon, anesthesia, nursing, imaging, and laboratory) is required for ERAS quality improvement in the pre-, intra-, and postoperative processes. Process elements in each of the operative areas can be audited, evaluated, compared, and modified/improved.

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The first national survey of anesthesia techniques for fetal therapies in Japan

Cited by 7 publications

References 11 publications

Fetally‐injected drugs for immobilization and analgesia do not modify fetal brain development in a rabbit model

Fetally‐injected drugs for immobilization and analgesia do not modify fetal brain development in a rabbit model

Seguridad de la anestesia neuroaxial en mujeres con embarazo gemelar y síndrome de transfusión feto-fetal, sometidas a fotocoagulación láser. Estudio de cohorte retrospectiva

Evaluation of the Fetal Therapy Evidence in Lower Urinary Tract Obstruction: Would an ERAS Guideline Improve Outcomes?

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