Foetal anaesthesia and analgesia during intrauterine procedures: Review
Authors:
Berka I.a 1; Šebková S.a 1; Feyereislová S.a 1; Ščamburová J.b 1; Hašlík L.c 1; Straňák Z.a 1
Authors‘ workplace:
b Anesteziologie, Ústav pro péči o matku a dítě
1; c Centrum fetální medicíny, Ústav pro péči o matku a dítě
1; a Jednotka intenzivně-resuscitační péče o novorozence, Ústav pro péči o matku a dítě
1; 3. lékařská fakulta, Univerzita Karlova
2
Published in:
Anest. intenziv. Med., 28, 2017, č. 5, s. 275-281
Category:
Review Article
Overview
The first internationally collaborating Centre of Foetal Medicine (CFM) in the Czech Republic was founded in 2012. It specialises in diagnostic procedures and treatment options of severe complications during foetal intrauterine development. The programme of CFM focuses mainly on the problematic issues of multiple pregnancies (including the twin-to-twin transfusion syndrome of monochorionic twins, selective intrauterine growth restriction, anaemia-polycythaemia syndrome etc.) and the area of in-utero treatments for congenital disorders and malformations (e.g. congenital diaphragmatic hernia, neural tube defects).
One of the inherent requirements of invasive foetal procedures in utero is the availability and cooperation of a multidisciplinary team, including the need for optimisation of super-specialized anaesthesiological approaches to both the mother and the foetus. Anaesthesiological care is an integral part to foetal medicine, as it plays a crucial role within the multidisciplinary approach to the complex care of critically ill foetuses, and has a major impact on the possible outcome of in-utero treatments.
We therefore aim to present to the reader an up-to-date overview of the possible approaches to anaesthesia and analgesia of the foetus during invasive in-utero treatments.
Keywords:
foetus – foetal pain – foetal surgery – foetal anaesthesia – foetal analgesia
Sources
1. Deprest JA, Flake AW, Gratacos E, Ville Y, Hecher K, Nicolaides K, Harrison MR. The making of fetal surgery. Prenat Diagn. 2010;30:653–667.
2. http://www.neonatology.cz/vysledky-pece-v-cr (25. 3. 2017)
3. http://www.fetalnicentrum.cz (25. 3. 2017)
4. Watt-Watson J, Hunter J, Pennefather P, Librach L, Raman-Wilms L, Schreiber M, et al. An integrated undergraduate pain curriculum, based on IASP curricula, for six health science faculties. Pain. 2004;110:140–148.
5. Konstantinidou AD, Silos-Santiago I, Flaris N, Snider WD. Development of the primary afferent projection in human spinal cord. J Comp Neurol. 1995; 354:11–12.
6. Fitzgerald M. The development of nociceptive circuits. Nat Rev Neurosci. 2005; 6:507–520.
7. Lee SJ, Ralston HJP, Drey EA, Partridge JC, Rosen MA. Fetal pain: a systematic multidisciplinary review of the evidence. JAMA. 2005;294:947–954.
8. Smith RP, Gitau R, Glover V, Fisk NM. Pain and stress in the human fetus. Eur J Obstet Gynecol Reprod Biol. 2000;92:161–165.
9. Fisk NM, Gitau R, Teixeira JM, Giannakoulopoulos X, Cameron AD, Glover VA. Effect of direct fetal opioid analgesia on fetal hormonal and hemodynamic stress response to intrauterine needling. Anesthesiology. 2001;95:828–835.
10. Anand KJ, Celeste Johnston C, Oberlander TF, Taddio A, Tutag Lehr V, Walco GA. Analgesia and local anesthesia during invasive procedures in the neonate. Clin Ther. 2005;27:844–876.
11. Anand KJ, Coskun V, Thrivikraman KV, Nemeroff CB, Plotsky PM. Long-term behavioral effects of repetitive pain in neonatal rat pups. Physiol Behav. 1999;66: 627–637.
12. Anand KJ. Clinical importance of pain and stress in preterm neonates. Biol Neonate. 1998;73:1–9.
13. Porter FL, Grunau RE, Anand KJ. Long-term effects of pain in infants. J Dev Behav Pediatr. 1999;20:253–261.
14. Liley AW. Intrauterine Transfusion of Foetus in Haemolytic Disease. British Medical Journal. 1963;1107–1109.
15. Kohl T. Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part I: surgical technique and perioperative outcome. Ultrasound Obstet Gynecol. 2014;44:515–524.
16. Ferschl M, Lee H, Rollins MD. Anesthesia for in utero repair of myelomeningocele. Anesthesiology. 2013;118:1211–1223.
17. Ruano R, Ali RA, Patel P, Cass D, Olutoye O, Belfort MA. Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: indications, outcomes, and future directions. Obstet Gynecol Surv. 2014;3:147–158.
18. Pedra SF, Peralta CF, Pedra CAC. Future directions of fetal interventions in congenital heart disease. Interv Cardiol Clin. 2013;2:1–10.
19. van Klink JM, Koopman HM, van Zwet EW. Cerebral injury and neurodevelopmental impairment after amnioreduction versus laser surgery in twin-twin transfusion syndrome: a systematic review and meta-analysis. Fetal Diagn Ther. 2013;33:81–89.
20. Taghavi K, Beasley S. The ex utero intrapartum treatment (EXIT) procedure: application of a new therapeutic paradigm. J Paediatr Child Health. 2013;420–427.
21. Rychik J. Fetal cardiovascular physiology. Pediatr Cardiol. 2004;25:201–209.
22. Alfirevic Z, Stampalija T, Gyte GM. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev. 2013;12:CD007529.
23. Van de Velde M, De Buck F. Fetal and maternal analgesia/anesthesia for fetal procedures. Fetal Diagn Ther. 2012;31:201–209.
24. Boat A, Mahmoud M, Michelfelder EC, Lin E, Ngamprasertwong P, Schnell B, Kurth CD, Crombleholme TM, Sadhasivam S. Supplementing desflurane with intravenous anesthesia reduces fetal cardiac dysfunction during open fetal surgery. Paediatr Anaesth. 2010;20:748–756.
25. Brambrink AM, Evers AS, Avidan MS, Farber NB, Smith DJ, Zhang X, Dissen GA, Creeley CE, Olney JW. Isoflurane-induced neuroapoptosis in the neonatal rhesus macaque brain. Anesthesiology. 2010;112:834–841.
26. Flick RP, Katusic SK, Colligan RC, Wilder RT, Voigt RG, Olson MD, Sprung J, Weaver AL, Schroeder DR, Warner DO. Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics. 2011;128:1053–1061.
27. Stratmann G. Neurotoxicity of anesthetic drugs in the developing brain. Anesth Analg. 2011;113:1170–1179.
28. Sala P, Prefumo F, Pastorino D, Buffi D, Gaggero CR, Foppiano M, De Biasio P. Fetal surgery: an overview. Obstet Gynecol Surv. 2014;4:218–228.
29. Casella DP, Tomaszewski JJ, Ost MC.Posterior urethral valves: renal failure and prenatal treatment. Int J Nephrol. 2012;2012:351067.
30. Van de Velde M, De Buck F, Van Mieghem T, Gucciardo L, De Koninck P, Deprest J. Fetal anaesthesia: is this necessary for fetoscopic therapy? Fet Matern Med Rev. 2010;21:24–35.
31. Van de Velde M, Van Schoubroeck D, Lewi LE, Marcus MA, Jani JC, Missant C, et al. Remifentanil for fetal immobilization and maternal sedation during fetoscopic surgery: a randomized, double-blind comparison with diazepam. Anesth Analg. 2005; 101:251–258.
32. Schuurmans J, Benders M, Lemmers P, van Bel F. Neonatal morphine in extremely and very preterm neonates: its effect on the developing brain – a review. J Matern Fetal Neonatal Med. 2015;2:222–228.
33. Marinucci L, Balloni S, Carinci F, Locci P, Pezzetti F, Bodo M. Diazepam effects on non-syndromic cleft lip with or without palate: epidemiological studies, clinical findings,genes and extracellular matrix. Expert Opin Drug Saf. 2011;10:23–33.
34. Kampe S, Krombach JW, Diefenbach C. Muscle relaxants. Best Pract Res Clin Anaesthesiology. 2003;17:137–146.
35. Garcia PJ, Olutoye OO, Ivey RT, Olutoye OA. Case scenario: anesthesia for maternal-fetal surgery: the Ex Utero Intrapartum Therapy (EXIT) procedure. Anesthesiology. 2011;114:1446–1452.
36. Moldenhauer JS. Ex utero intrapartum therapy. Semin Pediatr Surg. 2013;22:44–49.
37. Marwan A, Crombleholme TM. The EXIT procedure: principles, pitfalls, and progress. Semin Pediatr Surg. 2006;15:107–115.
38. The Royal College of Obstetricians and Gynaecologists. The Care of Women Requesting Induced Abortion. Evidence-Based Clinical Guideline no. 7. RCOG Press. 2015.
39. https://www.fda.gov/Drugs/DrugSafety/ucm532356.htm (14. 12. 2016)
Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2017 Issue 5
Most read in this issue
- Succesful use of methylene blue in a patient with refractory shock on veno-arterial extracorporeal membrane oxygenation
- Cognitive disorders in perioperative and intensive care
- Neurotoxicity of anaesthetics on the developing brain
- The endothelial glycocalyx and fluid therapy in critical care and perioperative medicine