Donepudi Roopali, Huynh Melissa, Moise Kenneth J, Papanna Ramesha, Johnson Anthony, Austin Mary, Tsao KuoJen, Jain Ranu
The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas,
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas,
Fetal Diagn Ther. 2019;45(3):192-196. doi: 10.1159/000487883. Epub 2018 Apr 19.
Optimal uterine relaxation is achieved through higher minimum alveolar concentration (MAC) of inhalational anesthetics, increasing risks to mother and fetus. Our objective was to determine if earlier administration of magnesium sulfate would reduce the requirement of inhalational anesthetics in fetal myelomeningocele repair.
Prospective observational study of fetal myelomeningocele repair was performed from September 2011 to August 2017. Groups compared were: (1) magnesium sulfate at uterine closure; (2) magnesium sulfate at maternal skin incision. Maternal demographics, anesthetic agents, intraoperative complications, and pregnancy outcomes were reviewed. A Student t test was used for analysis.
There were 30 cases in group 1 and 21 cases in group 2. There was no difference in gestational age at intervention (24.92 ± 0.62 vs. 25.22 ± 0.47 weeks, p = 0.07) or at delivery (34.83 ± 2.77 vs. 33.98 ± 3.83 weeks, p = 0.38) between groups 1 and 2, respectively. The maximum MAC of sevoflurane was significantly lower in group 2 (1.84 ± 0.25 vs. 1.05 ± 0.28, p < 0.0001). There was no difference in the average dose of phenylephrine used.
Magnesium sulfate infusion initiated earlier in open fetal surgery reduces the total anesthetic exposure to the fetus.
通过提高吸入麻醉剂的最低肺泡浓度（MAC）可实现最佳的子宫松弛，但这会增加对母亲和胎儿的风险。我们的目的是确定更早给予硫酸镁是否会降低胎儿脊髓脊膜膨出修补术中吸入麻醉剂的需求量。
对2011年9月至2017年8月期间进行的胎儿脊髓脊膜膨出修补术进行前瞻性观察研究。比较的组为：（1）子宫关闭时给予硫酸镁；（2）产妇皮肤切开时给予硫酸镁。回顾产妇的人口统计学资料、麻醉剂、术中并发症和妊娠结局。采用学生t检验进行分析。
第1组有30例，第2组有21例。第1组和第2组在干预时的孕周（分别为24.92±0.62周和25.22±0.47周，p = 0.07）或分娩时的孕周（分别为34.83±2.77周和33.98±3.83周，p = 0.38）方面无差异。第2组七氟醚的最大MAC显著更低（分别为1.84±0.25和1.05±0.28，p < 0.0001）。使用去氧肾上腺素的平均剂量无差异。
在开放性胎儿手术中更早开始输注硫酸镁可减少胎儿总的麻醉暴露量。
