Department of Anaesthesiology, UZ Leuven, Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Obstetrics and Gynaecology, UZ Leuven, Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
Best Pract Res Clin Anaesthesiol. 2024 Jun;38(2):93-102. doi: 10.1016/j.bpa.2024.04.008. Epub 2024 Apr 27.
Nowadays, widespread antenatal ultrasound screenings detect congenital anomalies earlier and more frequently. This has sparked research into foetal surgery, offering treatment options for various conditions. These surgeries aim to correct anomalies or halt disease progression until after birth. Minimally invasive procedures can be conducted under local anaesthesia (with/without maternal sedation), while open mid-gestational procedures necessitate general anaesthesia. Anaesthesia serves to prevent maternal and foetal pain, to provide immobilization, and to optimize surgical conditions by ensuring uterine relaxation. As early as 12 weeks after conception, the foetus may experience pain. Thus, in procedures involving innervated foetal tissue or requiring foetal immobilization, anaesthetic drugs can be administered directly to the foetus (intramuscular or intravenous) or indirectly (transplacental) to the mother. However, animal studies have indicated that exposure to prenatal anaesthesia might impact foetal brain development, translating these findings to the clinical setting remains difficult.
如今，广泛的产前超声筛查更早、更频繁地发现先天性异常。这引发了对胎儿手术的研究，为各种疾病提供了治疗选择。这些手术旨在纠正异常或阻止疾病进展，直到分娩后。局部麻醉（有/无母亲镇静）下可进行微创手术，而中孕期的开放性手术则需要全身麻醉。麻醉的目的是预防母亲和胎儿的疼痛，提供固定，并通过确保子宫松弛来优化手术条件。早在受孕后 12 周，胎儿就可能感到疼痛。因此，在涉及有神经支配的胎儿组织或需要胎儿固定的手术中，可以直接将麻醉药物（肌肉内或静脉内）给予胎儿，或间接（经胎盘）给予母亲。然而，动物研究表明，产前麻醉暴露可能会影响胎儿大脑发育，将这些发现转化到临床环境仍然具有挑战性。
