Anesthesia for Fetal Surgery and Fetal Procedures

Advances in imaging and technique have pushed the boundaries of the types of surgical interventions available to fetuses with congenital and developmental abnormalities. This review focuses on fundamental aspects of fetal anesthesia, including the physiologic changes of pregnancy, uteroplacental perfusion, and fetal physiology. We discuss the types of fetal surgeries and procedures currently being performed and discuss the specific anesthetic approaches to different categories of fetal surgeries. We also discuss ethical aspects of fetal surgery and anesthesia.
Source: Clinics in Perinatology - Category: Perinatology & Neonatology Authors: Source Type: research

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​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; &AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regio...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
(Anaesthesia. 2018;73:839–846) Preeclampsia is a common complication of pregnancy. In the past, anesthesiologists had sometimes avoided the use of spinal anesthesia in parturients with preeclampsis due to concerns about spinal-induced hypotension leading to inadequate uteroplacental perfusion. However, more recent studies have shown spinal anesthesia to be a safe technique in preeclamptic women as the hypotension associated with it is less severe than that experienced by normotensive parturients and is easily treated. However, effective treatment of postspinal hypotension remains an important component of anesthetic...
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Anesthesia and Analgesia: Regional Anesthesia Source Type: research
In this study, we analyzed the corticocortical projections of L6b/SP neurons in the mouse cortex and searched for a marker gene expressed in L6b/SP neurons that have ipsilateral inter-areal projections. Retrograde tracing experiments demonstrated that L6b/SP neurons in the primary somatosensory cortex (S1) projected to the primary motor cortex (M1) within the same cortical hemisphere at postnatal day (PD) 2 but did not show any callosal projection. This unilateral projection pattern persisted into adulthood. Our microarray analysis identified the gene encoding a β subunit of voltage-gated potassium channel (Kcnab1) as...
Source: Frontiers in Neuroanatomy - Category: Neurology Source Type: research
Marcia H. Ratner, Vidhya Kumaresan and David H. Farb* Laboratory of Molecular Neurobiology, Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, United States Memory dysfunction is a symptomatic feature of many neurologic and neuropsychiatric disorders; however, the basic underlying mechanisms of memory and altered states of circuitry function associated with disorders of memory remain a vast unexplored territory. The initial discovery of endogenous neurosteroids triggered a quest to elucidate their role as neuromodulators in normal and diseased brain functio...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
This is a narrative review of recent articles (mainly published in 2017 and 2018) related to the conduct of cardiopulmonary bypass (CPB) that should be of interest to the cardiac anesthesiologist. Some of the topics covered include recent guidelines on temperature management, anticoagulation, perfusion practice, use of transesophageal echocardiography during CPB, optimal mean arterial pressure, vasoplegia, bleeding, perioperative anemia, post-cardiac surgery transfusion, acute kidney injury, delirium and cognitive decline, CPB during pregnancy, lung management, radial-to-femoral artery pressure gradients during CPB, prophy...
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Special Article Source Type: research
This article reviews several controversial aspects of management of nonobstetric surgery during pregnancy, including the optimal timing for nonurgent surgery, when to perform intraoperative fetal monitoring, modifications to anesthetic techniques to account for the physiologic changes of pregnancy, and management of maternal cardiac arrest.Recent FindingsThere have been several advances in the management of nonobstetric surgery during pregnancy, including the increased use of laparoscopic techniques, an improved understanding of the importance of adequate pain management, and new initiatives to improve the maternal cardiac...
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research
GL Ravindra, Abhinava S Madamangalam, Shwetha SeetharamaiahIndian Journal of Anaesthesia 2018 62(9):710-716 Anaesthesia for pregnant patients presenting for non-obstetric surgery needs a thorough understanding of the physiological changes and altered pharmacokinetics of pregnancy. Considering the effects of surgery and anaesthesia on the foetus, only essential and emergency surgeries are performed during pregnancy. Surgical procedures in second trimester have the advantage of better foetal outcome. The primary concerns of maternal and foetal safety are achieved by a focused multidisciplinary team-based approach with respe...
Source: Indian Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
(Aust N Z J Obstet Gynaecol 2017;57:540–551) Sepsis, caused by Group A beta hemolytic streptococcal (GAS) infection, is an increasing cause of maternal mortality in both Australia and the United Kingdom. Sepsis can lead to insufficiency in maternal circulation, leading to compromised fetal perfusion and fetal distress. The Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) has designed evidence-based guidelines for the effective investigation and management of sepsis in pregnant and postpartum women.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Editorials and Reviews Source Type: research
Conclusions: Findings from our experimental model suggest that the offspring of dams exposed to ozone during implantation had reduced growth compared with controls, possibly as a consequence of ozone-induced vascular dysfunction. https://doi.org/10.1289/EHP2019 Received: 10 April 2017 Revised: 7 November 2017 Accepted: 13 November 2017 Published: 21 December 2017 Address correspondence to C.N. Miller, U.S. Environmental Protection Agency, NHEERL/EPHD/CIB, 109 T.W. Alexander Dr., Mail Code: B105-02, Research Triangle Park, NC 27711. Telephone: 919-541-3469. Email: miller.colette@epa.gov Supplemental Material is availab...
Source: EHP Research - Category: Environmental Health Authors: Tags: Research Source Type: research
Regulators of G protein signaling (RGS) proteins are crucial in mediating vascular smooth muscle contraction via the regulation of heterotrimeric G proteins, affecting blood pressure and arterial blood flow. Previous studies by others and us showed that RGS2 deficiency augments vascular tone and impairs uterine blood flow (UBF) in non-pregnant mice, and that an Rgs2 loss-of-function mutation is linked to preeclampsia in humans; however, the mechanisms are unclear. Here, we tested the hypothesis that increased RGS2 expression and/or function facilitates placental perfusion by promoting vasodilation and UBF. We determined ge...
Source: Hypertension - Category: Cardiology Authors: Tags: Poster Abstract Presentations Source Type: research
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