Effects of Pregnancy Anesthesia on Fetal Nervous System

Li, Xingyue; Jiang, Xi; Zhao, Ping

doi:10.3389/fphar.2020.523514

Cited by 10 publications

(10 citation statements)

References 53 publications

(67 reference statements)

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“…An existing study showed that surgery in early pregnancy does not appear to increase the incidence of congenital defects in the fetus, but the abovementioned study did not consider the effect of anesthesia ( 19 ). Mid-pregnancy is a period of peak neuronal proliferation and migration and may also be a critical stage affecting neurodevelopment ( 20 ). More current clinical studies do not distinguish between early and mid-pregnancy anesthesia; therefore, the PAE presented in this section also mixes anesthesia exposure in early and mid-pregnancy.…”

Section: Pae and Neurodevelopment Of Clinical Trialsmentioning

confidence: 99%

Prenatal anesthetic exposure and offspring neurodevelopmental outcomes—A narrative review

et al. 2023

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While it is common for pregnant women to take anesthesia during surgery, the effects of prenatal anesthesia exposure (PAE) on the long-term neurodevelopment of the offspring remain to be clarified. Preclinical animal research has shown that in utero anesthetic exposure causes neurotoxicity in newborns, which is mainly characterized by histomorphological changes and altered learning and memory abilities. Regional birth cohort studies that are based on databases are currently the most convenient and popular types of clinical studies. Specialized questionnaires and scales are usually employed in these studies for the screening and diagnosis of neurodevelopmental disorders in the offspring. The time intervals between the intrauterine exposure and the onset of developmental outcomes often vary over several years and accommodate a large number of confounding factors, which have an even greater impact on the neurodevelopment of the offspring than prenatal anesthesia itself. This narrative review summarized the progress in prenatal anesthetic exposure and neurodevelopmental outcomes in the offspring from animal experimental research and clinical studies and provided a brief introduction to assess the neurodevelopment in children and potential confounding factors.

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Section: Pae and Neurodevelopment Of Clinical Trialsmentioning

confidence: 99%

Prenatal anesthetic exposure and offspring neurodevelopmental outcomes—A narrative review

et al. 2023

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“…Although there is no clear evidence of teratogenic effects of anesthetics, pregnant women should theoretically use anesthetics as little as possible and use the lowest clinically effective concentration. [33][34][35] Intravenous anesthetics (as represented by propofol) can quickly pass through the placenta; however, due to their rapid metabolism, the short-term use of these drugs has little impact on pregnant women and fetuses. Moreover, sevoflurane and desflurane are relatively safe in clinical dosages, but high concentrations may cause adverse hypotension.…”

Section: Avoiding Premature Birth and Abortionmentioning

confidence: 99%

Anaesthetic management of cerebral arteriovenous malformation hemorrhage during pregnancy: A case series

Liang

Liu

et al. 2023

Medicine

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Rationale: There is no clear consensus guidance for anesthesiologists on how to manage patients with cerebral arteriovenous malformation (cAVM) rupture and hemorrhage during pregnancy who need craniotomy. Our objective was to review the anesthesia management of pregnant women who underwent resection of cAVM at our institution and to provide opinions and suggestions. Patient concerns: Herein, we report of 3 patients with cAVM rupture and hemorrhage during pregnancy who underwent neurosurgery at the 22nd, 28th, and 20th weeks of pregnancy. Diagnoses: All 3 patients were admitted to the emergency department of our hospital due to sudden symptoms. Subsequently, their head imaging results confirmed the rupture and hemorrhage of cAVM. The rupture and hemorrhage of cAVM during pregnancy has a low incidence and high mortality, which seriously endangers the safety of the mother and fetus. For this emergency condition, craniotomy for removing intracranial lesions and clear hematoma can result in a chance of a successful delivery. Especially in the second and third trimesters of pregnancy, the management goal of anesthesia is to ensure the maternofetal safety and to maintain continuous pregnancy. Interventions: This article describes the process of intraoperative anesthesia management and maternal-fetal outcomes and discusses the key issues for the anesthesia management of cAVM rupture during pregnancy, including considerations of physiological changes during pregnancy and anesthesia medication, intraoperative monitoring, the maintenance of hemodynamic stability, and the control of intracranial pressure, among other considerations. Resection of intracranial lesions should be performed whenever possible while maintaining the pregnancy for better maternal and infant outcomes. Outcomes: The operations of the 3 pregnant women were successfully completed under our detailed anesthesia planning and careful anesthesia management. All the patients recovered well after the operation, and underwent cesarean section to give birth smoothly. Lessons: The preservation of pregnancy under cAVM resection is a complex challenge for anesthesiologists, and these 3 cases provide an extensive amount of experience for anesthesia management in similar situations. Detailed anesthesia planning and careful anesthesia management by anesthesiologists are important guarantees for good maternal and fetal outcomes.

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“…Given medical uncertainty in the largely untested domain of fetal risk, pregnant patients could be denied treatment, including cancer treatment, 1 addiction medicine, 2 x-rays, 3 or anesthesia. 4 In both situations, providers may mistakenly perceive that the Court's view of potential fetal life requires them to either provide or withhold medical treatment from pregnant patients to protect fetal well-being. This, however, is a misreading of Dobbs and a misinterpretation of providers' legal and ethical obligations; Dobbs imposes no such requirement.…”

Section: I: Dobbs and Medical Decision-makingmentioning

confidence: 99%

From Constitutional Protections to Medical Ethics: The Future of Pregnant Patients’ Medical Self-Determination Rights After Dobbs

Sawicki,

Kukura

2023

J. Law. Med. Ethics

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This article argues that the Supreme Court’s decision in Dobbs is likely to impact medical decision-making by pregnant patients in a variety of contexts. Of particular concern are situations where a patient declines treatment recommended for its potential benefit to the fetus and situations where treatment is withheld due to potential risk to the fetus. The Court’s elevation of fetal interests, combined with a history of courts using abortion jurisprudence to guide their reasoning in compelled treatment cases, means that Dobbs has the potential to limit patient autonomy in a wide array of clinical settings. The article calls on professional medical associations to issue ethical guidance affirming the duty to respect the medical self-determination of pregnant patients.

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Effects of Pregnancy Anesthesia on Fetal Nervous System

Cited by 10 publications

References 53 publications

Prenatal anesthetic exposure and offspring neurodevelopmental outcomes—A narrative review

Prenatal anesthetic exposure and offspring neurodevelopmental outcomes—A narrative review

Anaesthetic management of cerebral arteriovenous malformation hemorrhage during pregnancy: A case series

From Constitutional Protections to Medical Ethics: The Future of Pregnant Patients’ Medical Self-Determination Rights After Dobbs

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