Foetal exposure to anaesthesia during pregnancy: anaesthesia-induced neurotoxicity, surgery & anaesthesia conduct
Indications for exposure of pregnant women to anaesthesia include (emergent) maternal non-obstetric surgery (e.g., laparoscopic appendectomy), maternal obstetric surgery (e.g., cervical cerclage) and foetal surgery (e.g., prenatal surgery on the foetus to repair spina bifida). Maternal non-obstetric...
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| description | Indications for exposure of pregnant women to anaesthesia include (emergent) maternal non-obstetric surgery (e.g., laparoscopic appendectomy), maternal obstetric surgery (e.g., cervical cerclage) and foetal surgery (e.g., prenatal surgery on the foetus to repair spina bifida). Maternal non-obstetric surgery is the most frequent indication with an incidence of 0.4-1% of pregnant women. In all these cases, the anaesthetic drugs administered to the mother easily cross the placenta and reach the foetus. Foetal brain development is a complex and delicate process which may be disturbed by anaesthetic drugs (referred to as anaesthesia-induced neurotoxicity), but also by maternal surgery and the conduct of anaesthesia (aiming to maintain physiologic maternal homeostasis during anaesthesia). Therefore, the effects of these three factors on foetal brain development were further investigated in this thesis.
Anaesthetic drugs and surgery
Before starting the preclinical and clinical studies of this thesis, we performed a systematic review and meta-analysis of all studies investigating the effects of general anaesthesia during pregnancy on the neurocognitive development of the foetus. This meta-analysis concluded that anaesthesia-induced neurotoxicity during pregnancy was a consistent finding in preclinical studies, but translation of these results to the clinical situation was limited by several factors. Only one clinical study has been published after completion of this meta-analysis, but this study has several important limitations. The sensitivity analysis of our meta-analysis suggested that neurodevelopmental effects were much smaller in models mimicking typical clinical situations (e.g., realistic durations of exposure to anaesthesia) and applying clinically routine monitoring standards.
Therefore, we investigated in the sheep model the neurodevelopmental effects of cumulative durations of prenatal anaesthesia exposure corresponding to approximately 5 and 10 hours in humans and compared this with unexposed sheep. Clinical routine monitoring standards were performed during this anaesthesia for a maternal laparotomy. This study could not find evidence for either neuronal injury or neurobehavioural impairments of the lambs after a cumulative duration of prenatal anaesthesia exposure corresponding to even 10 hours in humans. Luckily, exposure of pregnant women to more than 10 hours of general anaesthesia is required in only 0.5% of pregnant women requiring non-obstetr |
| format | Dissertation |
| fullrecord | <record><control><sourceid>kuleuven_FZOIL</sourceid><recordid>TN_cdi_kuleuven_dspace_20_500_12942_701566</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>20_500_12942_701566</sourcerecordid><originalsourceid>FETCH-kuleuven_dspace_20_500_12942_7015663</originalsourceid><addsrcrecordid>eNqVzLEKwjAUheEsDlJ9hzs5iJW0tRVdxeIDuIeQ3NZgSWpyI-3bq-Cgm05nOD_flN1qhyQ7wKF3IXoEciCtxEAXDEaCjt7YFnqPrZVWjfvPNzVWR4UaLEbvyA1GGRpX8IRa9CMsvijlXjXN2KSRXcD5exO2rI_nwym9xg7jHa3QoZcKRc5FybnI8t0mF1uelVVVJGz9cyxooOIv_QHmoFhv</addsrcrecordid><sourcetype>Institutional Repository</sourcetype><iscdi>true</iscdi><recordtype>dissertation</recordtype></control><display><type>dissertation</type><title>Foetal exposure to anaesthesia during pregnancy: anaesthesia-induced neurotoxicity, surgery & anaesthesia conduct</title><source>Lirias (KU Leuven Association)</source><creator>Bleeser, Tom</creator><creatorcontrib>Bleeser, Tom ; Rex, Steffen ; Deprest, Jan</creatorcontrib><description>Indications for exposure of pregnant women to anaesthesia include (emergent) maternal non-obstetric surgery (e.g., laparoscopic appendectomy), maternal obstetric surgery (e.g., cervical cerclage) and foetal surgery (e.g., prenatal surgery on the foetus to repair spina bifida). Maternal non-obstetric surgery is the most frequent indication with an incidence of 0.4-1% of pregnant women. In all these cases, the anaesthetic drugs administered to the mother easily cross the placenta and reach the foetus. Foetal brain development is a complex and delicate process which may be disturbed by anaesthetic drugs (referred to as anaesthesia-induced neurotoxicity), but also by maternal surgery and the conduct of anaesthesia (aiming to maintain physiologic maternal homeostasis during anaesthesia). Therefore, the effects of these three factors on foetal brain development were further investigated in this thesis.
Anaesthetic drugs and surgery
Before starting the preclinical and clinical studies of this thesis, we performed a systematic review and meta-analysis of all studies investigating the effects of general anaesthesia during pregnancy on the neurocognitive development of the foetus. This meta-analysis concluded that anaesthesia-induced neurotoxicity during pregnancy was a consistent finding in preclinical studies, but translation of these results to the clinical situation was limited by several factors. Only one clinical study has been published after completion of this meta-analysis, but this study has several important limitations. The sensitivity analysis of our meta-analysis suggested that neurodevelopmental effects were much smaller in models mimicking typical clinical situations (e.g., realistic durations of exposure to anaesthesia) and applying clinically routine monitoring standards.
Therefore, we investigated in the sheep model the neurodevelopmental effects of cumulative durations of prenatal anaesthesia exposure corresponding to approximately 5 and 10 hours in humans and compared this with unexposed sheep. Clinical routine monitoring standards were performed during this anaesthesia for a maternal laparotomy. This study could not find evidence for either neuronal injury or neurobehavioural impairments of the lambs after a cumulative duration of prenatal anaesthesia exposure corresponding to even 10 hours in humans. Luckily, exposure of pregnant women to more than 10 hours of general anaesthesia is required in only 0.5% of pregnant women requiring non-obstetric surgery.
In clinical practice, pregnant women are exposed to anaesthesia almost exclusively to perform surgery, but it remains unknown whether and how surgery (and herewith associated inflammation) contributes to neurotoxicity. We compared in the rabbit model the effects on foetal brain development of general anaesthesia plus maternal abdominal surgery (a laparoscopic appendectomy) versus general anaesthesia without surgery. By this, we aimed to disentangle the neurodevelopmental effects of anaesthesia from those of surgery. We observed only limited impairments after maternal abdominal surgery, but the high foetal mortality rates limit translation of these results to the clinical scenario.
Anaesthesia conduct
Two important elements of anaesthesia conduct were investigated in this thesis: maternal blood pressure management and maternal ventilation.
Current clinical guidelines recommend treating anaesthesia-induced hypotension using phenylephrine or noradrenaline, with the rationale to maintain uterine perfusion pressure and uterine blood flow. Evidence for this strategy during general anaesthesia for non-obstetric surgery is absent. Therefore, we compared the neurodevelopmental outcome of foetal rabbits of mothers receiving no treatment for maternal hypotension during anaesthesia with a group of pups for which maternal blood pressure is maintained above 80% of the awake baseline value using noradrenaline. Treatment of anaesthesia-induced hypotension using noradrenaline did not affect neuron densities, but significantly less foetal survival, lower sensory scores in the neurobehavioural assessment and less proliferation were observed post-partum in the noradrenaline-group when compared with the hypotension-group. We speculate that the observed differences are due to a decreased uterine blood flow caused by vasoconstriction, as suggested by several older preclinical studies. Therefore, further research is needed on the optimal haemodynamic management during general anaesthesia for pregnant women.
During pregnancy, progesterone coordinates an increase in maternal minute ventilation, resulting in a physiological mild respiratory alkalosis relative to non-pregnant blood gas values. Current clinical guidelines therefore recommend that maternal arterial paCO2 should be maintained at 30 mmHg during anaesthesia for non-obstetric and foetal surgery. Yet, there is no evidence that this ensures optimal conditions for the foetus. Therefore, pregnant ewes were anaesthetized and randomized to one target of maternal paCO2 between 19 and 50 mmHg. We aimed to determine in the ovine model which target of maternal ventilation (maternal paCO2) ensures normal foetal blood gas values in two surgical settings: non-obstetric surgery and foetal surgery for prenatal spina bifida repair using partial amniotic CO2 insufflation. This study provided experimental evidence and confirms the clinical recommendation that maternal paCO2 should be maintained close to the physiologic value of 30 mmHg during general anaesthesia in pregnancy.
Clinical observational study: anaesthetic drugs, surgery and anaesthesia conduct
In clinical practice, pregnant women are exposed to the combination of anaesthetic drugs and surgery with adherence to the current recommendations regarding the conduct of anaesthesia. We performed an ambidirectional cohort study with retrospective assessment of prenatal exposure to anaesthesia in children born between 2001 and 2018 and prospective assessment of neurodevelopmental outcomes in 2020-2021. Exposed children had in utero exposure to anaesthesia for maternal non-obstetric surgery in a tertiary referral centre. Unexposed children lacked this exposure. When the entire study population was analysed, no evidence could be found for an association between prenatal exposure to anaesthesia and impairment of neurodevelopmental outcomes in childhood. However, this study could not exclude clinically relevant differences in subgroups of vulnerable patients, for specific procedures and for specific neurocognitive subdomains.
Conclusion
The sensitivity analysis of our meta-analysis, our preclinical study in sheep, and our clinical observational study all have the same conclusion: for the typical emergency procedures occurring most commonly during pregnancy, there was no evidence for an association between prenatal anaesthesia exposure and an impaired neurodevelopmental outcome. However, these studies could not preclude neurobehavioural impairments in the exceptional cases in which pregnant women need to undergo repeated or excessively prolonged anaesthesia exposure (e.g., weeklong sedation on the intensive care unit).
Our study aiming to disentangle the neurodevelopmental effects of anaesthesia from those of surgery remains inconclusive as the high foetal mortality rates limit translation of these results to the clinical scenario.
While our preclinical studies provided experimental support for maintaining maternal paCO2 around the physiological awake values during general anaesthesia, our experiments raised concern that using noradrenaline to treat maternal hypotension may impair foetal brain development, which requires further research.</description><language>eng</language><creationdate>2022</creationdate><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>311,315,776,27837</link.rule.ids><linktorsrc>$$Uhttps://lirias.kuleuven.be/handle/20.500.12942/701566$$EView_record_in_KU_Leuven_Association$$FView_record_in_$$GKU_Leuven_Association</linktorsrc></links><search><creatorcontrib>Bleeser, Tom</creatorcontrib><title>Foetal exposure to anaesthesia during pregnancy: anaesthesia-induced neurotoxicity, surgery & anaesthesia conduct</title><description>Indications for exposure of pregnant women to anaesthesia include (emergent) maternal non-obstetric surgery (e.g., laparoscopic appendectomy), maternal obstetric surgery (e.g., cervical cerclage) and foetal surgery (e.g., prenatal surgery on the foetus to repair spina bifida). Maternal non-obstetric surgery is the most frequent indication with an incidence of 0.4-1% of pregnant women. In all these cases, the anaesthetic drugs administered to the mother easily cross the placenta and reach the foetus. Foetal brain development is a complex and delicate process which may be disturbed by anaesthetic drugs (referred to as anaesthesia-induced neurotoxicity), but also by maternal surgery and the conduct of anaesthesia (aiming to maintain physiologic maternal homeostasis during anaesthesia). Therefore, the effects of these three factors on foetal brain development were further investigated in this thesis.
Anaesthetic drugs and surgery
Before starting the preclinical and clinical studies of this thesis, we performed a systematic review and meta-analysis of all studies investigating the effects of general anaesthesia during pregnancy on the neurocognitive development of the foetus. This meta-analysis concluded that anaesthesia-induced neurotoxicity during pregnancy was a consistent finding in preclinical studies, but translation of these results to the clinical situation was limited by several factors. Only one clinical study has been published after completion of this meta-analysis, but this study has several important limitations. The sensitivity analysis of our meta-analysis suggested that neurodevelopmental effects were much smaller in models mimicking typical clinical situations (e.g., realistic durations of exposure to anaesthesia) and applying clinically routine monitoring standards.
Therefore, we investigated in the sheep model the neurodevelopmental effects of cumulative durations of prenatal anaesthesia exposure corresponding to approximately 5 and 10 hours in humans and compared this with unexposed sheep. Clinical routine monitoring standards were performed during this anaesthesia for a maternal laparotomy. This study could not find evidence for either neuronal injury or neurobehavioural impairments of the lambs after a cumulative duration of prenatal anaesthesia exposure corresponding to even 10 hours in humans. Luckily, exposure of pregnant women to more than 10 hours of general anaesthesia is required in only 0.5% of pregnant women requiring non-obstetric surgery.
In clinical practice, pregnant women are exposed to anaesthesia almost exclusively to perform surgery, but it remains unknown whether and how surgery (and herewith associated inflammation) contributes to neurotoxicity. We compared in the rabbit model the effects on foetal brain development of general anaesthesia plus maternal abdominal surgery (a laparoscopic appendectomy) versus general anaesthesia without surgery. By this, we aimed to disentangle the neurodevelopmental effects of anaesthesia from those of surgery. We observed only limited impairments after maternal abdominal surgery, but the high foetal mortality rates limit translation of these results to the clinical scenario.
Anaesthesia conduct
Two important elements of anaesthesia conduct were investigated in this thesis: maternal blood pressure management and maternal ventilation.
Current clinical guidelines recommend treating anaesthesia-induced hypotension using phenylephrine or noradrenaline, with the rationale to maintain uterine perfusion pressure and uterine blood flow. Evidence for this strategy during general anaesthesia for non-obstetric surgery is absent. Therefore, we compared the neurodevelopmental outcome of foetal rabbits of mothers receiving no treatment for maternal hypotension during anaesthesia with a group of pups for which maternal blood pressure is maintained above 80% of the awake baseline value using noradrenaline. Treatment of anaesthesia-induced hypotension using noradrenaline did not affect neuron densities, but significantly less foetal survival, lower sensory scores in the neurobehavioural assessment and less proliferation were observed post-partum in the noradrenaline-group when compared with the hypotension-group. We speculate that the observed differences are due to a decreased uterine blood flow caused by vasoconstriction, as suggested by several older preclinical studies. Therefore, further research is needed on the optimal haemodynamic management during general anaesthesia for pregnant women.
During pregnancy, progesterone coordinates an increase in maternal minute ventilation, resulting in a physiological mild respiratory alkalosis relative to non-pregnant blood gas values. Current clinical guidelines therefore recommend that maternal arterial paCO2 should be maintained at 30 mmHg during anaesthesia for non-obstetric and foetal surgery. Yet, there is no evidence that this ensures optimal conditions for the foetus. Therefore, pregnant ewes were anaesthetized and randomized to one target of maternal paCO2 between 19 and 50 mmHg. We aimed to determine in the ovine model which target of maternal ventilation (maternal paCO2) ensures normal foetal blood gas values in two surgical settings: non-obstetric surgery and foetal surgery for prenatal spina bifida repair using partial amniotic CO2 insufflation. This study provided experimental evidence and confirms the clinical recommendation that maternal paCO2 should be maintained close to the physiologic value of 30 mmHg during general anaesthesia in pregnancy.
Clinical observational study: anaesthetic drugs, surgery and anaesthesia conduct
In clinical practice, pregnant women are exposed to the combination of anaesthetic drugs and surgery with adherence to the current recommendations regarding the conduct of anaesthesia. We performed an ambidirectional cohort study with retrospective assessment of prenatal exposure to anaesthesia in children born between 2001 and 2018 and prospective assessment of neurodevelopmental outcomes in 2020-2021. Exposed children had in utero exposure to anaesthesia for maternal non-obstetric surgery in a tertiary referral centre. Unexposed children lacked this exposure. When the entire study population was analysed, no evidence could be found for an association between prenatal exposure to anaesthesia and impairment of neurodevelopmental outcomes in childhood. However, this study could not exclude clinically relevant differences in subgroups of vulnerable patients, for specific procedures and for specific neurocognitive subdomains.
Conclusion
The sensitivity analysis of our meta-analysis, our preclinical study in sheep, and our clinical observational study all have the same conclusion: for the typical emergency procedures occurring most commonly during pregnancy, there was no evidence for an association between prenatal anaesthesia exposure and an impaired neurodevelopmental outcome. However, these studies could not preclude neurobehavioural impairments in the exceptional cases in which pregnant women need to undergo repeated or excessively prolonged anaesthesia exposure (e.g., weeklong sedation on the intensive care unit).
Our study aiming to disentangle the neurodevelopmental effects of anaesthesia from those of surgery remains inconclusive as the high foetal mortality rates limit translation of these results to the clinical scenario.
While our preclinical studies provided experimental support for maintaining maternal paCO2 around the physiological awake values during general anaesthesia, our experiments raised concern that using noradrenaline to treat maternal hypotension may impair foetal brain development, which requires further research.</description><fulltext>true</fulltext><rsrctype>dissertation</rsrctype><creationdate>2022</creationdate><recordtype>dissertation</recordtype><sourceid>FZOIL</sourceid><recordid>eNqVzLEKwjAUheEsDlJ9hzs5iJW0tRVdxeIDuIeQ3NZgSWpyI-3bq-Cgm05nOD_flN1qhyQ7wKF3IXoEciCtxEAXDEaCjt7YFnqPrZVWjfvPNzVWR4UaLEbvyA1GGRpX8IRa9CMsvijlXjXN2KSRXcD5exO2rI_nwym9xg7jHa3QoZcKRc5FybnI8t0mF1uelVVVJGz9cyxooOIv_QHmoFhv</recordid><startdate>20220929</startdate><enddate>20220929</enddate><creator>Bleeser, Tom</creator><scope>FZOIL</scope></search><sort><creationdate>20220929</creationdate><title>Foetal exposure to anaesthesia during pregnancy: anaesthesia-induced neurotoxicity, surgery & anaesthesia conduct</title><author>Bleeser, Tom</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-kuleuven_dspace_20_500_12942_7015663</frbrgroupid><rsrctype>dissertations</rsrctype><prefilter>dissertations</prefilter><language>eng</language><creationdate>2022</creationdate><toplevel>online_resources</toplevel><creatorcontrib>Bleeser, Tom</creatorcontrib><collection>Lirias (KU Leuven Association)</collection></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Bleeser, Tom</au><format>dissertation</format><genre>dissertation</genre><ristype>THES</ristype><Advisor>Rex, Steffen</Advisor><Advisor>Deprest, Jan</Advisor><btitle>Foetal exposure to anaesthesia during pregnancy: anaesthesia-induced neurotoxicity, surgery & anaesthesia conduct</btitle><date>2022-09-29</date><risdate>2022</risdate><abstract>Indications for exposure of pregnant women to anaesthesia include (emergent) maternal non-obstetric surgery (e.g., laparoscopic appendectomy), maternal obstetric surgery (e.g., cervical cerclage) and foetal surgery (e.g., prenatal surgery on the foetus to repair spina bifida). Maternal non-obstetric surgery is the most frequent indication with an incidence of 0.4-1% of pregnant women. In all these cases, the anaesthetic drugs administered to the mother easily cross the placenta and reach the foetus. Foetal brain development is a complex and delicate process which may be disturbed by anaesthetic drugs (referred to as anaesthesia-induced neurotoxicity), but also by maternal surgery and the conduct of anaesthesia (aiming to maintain physiologic maternal homeostasis during anaesthesia). Therefore, the effects of these three factors on foetal brain development were further investigated in this thesis.
Anaesthetic drugs and surgery
Before starting the preclinical and clinical studies of this thesis, we performed a systematic review and meta-analysis of all studies investigating the effects of general anaesthesia during pregnancy on the neurocognitive development of the foetus. This meta-analysis concluded that anaesthesia-induced neurotoxicity during pregnancy was a consistent finding in preclinical studies, but translation of these results to the clinical situation was limited by several factors. Only one clinical study has been published after completion of this meta-analysis, but this study has several important limitations. The sensitivity analysis of our meta-analysis suggested that neurodevelopmental effects were much smaller in models mimicking typical clinical situations (e.g., realistic durations of exposure to anaesthesia) and applying clinically routine monitoring standards.
Therefore, we investigated in the sheep model the neurodevelopmental effects of cumulative durations of prenatal anaesthesia exposure corresponding to approximately 5 and 10 hours in humans and compared this with unexposed sheep. Clinical routine monitoring standards were performed during this anaesthesia for a maternal laparotomy. This study could not find evidence for either neuronal injury or neurobehavioural impairments of the lambs after a cumulative duration of prenatal anaesthesia exposure corresponding to even 10 hours in humans. Luckily, exposure of pregnant women to more than 10 hours of general anaesthesia is required in only 0.5% of pregnant women requiring non-obstetric surgery.
In clinical practice, pregnant women are exposed to anaesthesia almost exclusively to perform surgery, but it remains unknown whether and how surgery (and herewith associated inflammation) contributes to neurotoxicity. We compared in the rabbit model the effects on foetal brain development of general anaesthesia plus maternal abdominal surgery (a laparoscopic appendectomy) versus general anaesthesia without surgery. By this, we aimed to disentangle the neurodevelopmental effects of anaesthesia from those of surgery. We observed only limited impairments after maternal abdominal surgery, but the high foetal mortality rates limit translation of these results to the clinical scenario.
Anaesthesia conduct
Two important elements of anaesthesia conduct were investigated in this thesis: maternal blood pressure management and maternal ventilation.
Current clinical guidelines recommend treating anaesthesia-induced hypotension using phenylephrine or noradrenaline, with the rationale to maintain uterine perfusion pressure and uterine blood flow. Evidence for this strategy during general anaesthesia for non-obstetric surgery is absent. Therefore, we compared the neurodevelopmental outcome of foetal rabbits of mothers receiving no treatment for maternal hypotension during anaesthesia with a group of pups for which maternal blood pressure is maintained above 80% of the awake baseline value using noradrenaline. Treatment of anaesthesia-induced hypotension using noradrenaline did not affect neuron densities, but significantly less foetal survival, lower sensory scores in the neurobehavioural assessment and less proliferation were observed post-partum in the noradrenaline-group when compared with the hypotension-group. We speculate that the observed differences are due to a decreased uterine blood flow caused by vasoconstriction, as suggested by several older preclinical studies. Therefore, further research is needed on the optimal haemodynamic management during general anaesthesia for pregnant women.
During pregnancy, progesterone coordinates an increase in maternal minute ventilation, resulting in a physiological mild respiratory alkalosis relative to non-pregnant blood gas values. Current clinical guidelines therefore recommend that maternal arterial paCO2 should be maintained at 30 mmHg during anaesthesia for non-obstetric and foetal surgery. Yet, there is no evidence that this ensures optimal conditions for the foetus. Therefore, pregnant ewes were anaesthetized and randomized to one target of maternal paCO2 between 19 and 50 mmHg. We aimed to determine in the ovine model which target of maternal ventilation (maternal paCO2) ensures normal foetal blood gas values in two surgical settings: non-obstetric surgery and foetal surgery for prenatal spina bifida repair using partial amniotic CO2 insufflation. This study provided experimental evidence and confirms the clinical recommendation that maternal paCO2 should be maintained close to the physiologic value of 30 mmHg during general anaesthesia in pregnancy.
Clinical observational study: anaesthetic drugs, surgery and anaesthesia conduct
In clinical practice, pregnant women are exposed to the combination of anaesthetic drugs and surgery with adherence to the current recommendations regarding the conduct of anaesthesia. We performed an ambidirectional cohort study with retrospective assessment of prenatal exposure to anaesthesia in children born between 2001 and 2018 and prospective assessment of neurodevelopmental outcomes in 2020-2021. Exposed children had in utero exposure to anaesthesia for maternal non-obstetric surgery in a tertiary referral centre. Unexposed children lacked this exposure. When the entire study population was analysed, no evidence could be found for an association between prenatal exposure to anaesthesia and impairment of neurodevelopmental outcomes in childhood. However, this study could not exclude clinically relevant differences in subgroups of vulnerable patients, for specific procedures and for specific neurocognitive subdomains.
Conclusion
The sensitivity analysis of our meta-analysis, our preclinical study in sheep, and our clinical observational study all have the same conclusion: for the typical emergency procedures occurring most commonly during pregnancy, there was no evidence for an association between prenatal anaesthesia exposure and an impaired neurodevelopmental outcome. However, these studies could not preclude neurobehavioural impairments in the exceptional cases in which pregnant women need to undergo repeated or excessively prolonged anaesthesia exposure (e.g., weeklong sedation on the intensive care unit).
Our study aiming to disentangle the neurodevelopmental effects of anaesthesia from those of surgery remains inconclusive as the high foetal mortality rates limit translation of these results to the clinical scenario.
While our preclinical studies provided experimental support for maintaining maternal paCO2 around the physiological awake values during general anaesthesia, our experiments raised concern that using noradrenaline to treat maternal hypotension may impair foetal brain development, which requires further research.</abstract></addata></record> |
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| title | Foetal exposure to anaesthesia during pregnancy: anaesthesia-induced neurotoxicity, surgery & anaesthesia conduct |
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