Hoagland Monica A, Chatterjee Debnath
Department of Anesthesiology, Children's Hospital Colorado, Colorado Fetal Care Center, University of Colorado School of Medicine, Aurora, CO, USA.
Paediatr Anaesth. 2017 Apr;27(4):346-357. doi: 10.1111/pan.13109. Epub 2017 Feb 17.
Fetal therapy is an exciting and growing field of medicine. Advances in prenatal imaging and continued innovations in surgical and anesthetic techniques have resulted in a wide range of fetal interventions including minimally invasive, open mid-gestation, and ex-utero intrapartum treatment procedures. The potential for maternal morbidity is significant and must be carefully weighed against claimed benefits to the fetus. Appropriate patient selection is critical, and a multidisciplinary team-based approach is strongly recommended. The anesthetic management should focus on maintaining uteroplacental circulation, achieving profound uterine relaxation, optimizing surgical conditions, monitoring fetal hemodynamics, and minimizing maternal and fetal risk.
胎儿治疗是一个令人兴奋且不断发展的医学领域。产前影像学的进步以及手术和麻醉技术的持续创新，催生了一系列胎儿干预措施，包括微创、孕中期开放性手术以及宫外产时治疗程序。孕产妇发生并发症的可能性很大，必须仔细权衡其与对胎儿声称的益处。恰当的患者选择至关重要，强烈建议采用基于多学科团队的方法。麻醉管理应侧重于维持子宫胎盘循环、实现深度子宫松弛、优化手术条件、监测胎儿血流动力学以及将母婴风险降至最低。
