MATERNAL ANESTHESIA AND FETAL CEREBRAL OXYGENATION

产妇麻醉和胎儿脑氧合

• 批准号: 6620520
• 负责人: JAMES D REYNOLDS
• 金额: $ 18.29万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-12-15 至 2004-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6620520
• 关键词: anesthesia; anesthesia complication; biomedical equipment development; blood tests; cardiovascular function; cerebral ischemia /hypoxia; chemical structure function; embryo /fetus; embryo /fetus disorder; embryo /fetus drug adverse effect; fiber optics; growth /development; infrared spectrometry; isoflurane; mammalian embryology; oximetry; phenylamide; placental transfer; pregnancy; prenatal care; respiratory oxygenation; sheep; time resolved data

The goal of this exploratory/developmental grant is to use novel technology to determine and differentiate the effects of maternal general anesthesia to those of regional anesthesia on fetal cerebral oxygenation. Maintaining an adequate supply of oxygen and nutrients to the fetal brain is of primary importance during manipulations of the gravid female. Prevailing medical practice encourages the use of general anesthesia for such procedures as non-obstetric related surgery and emergent cesarean section. However, relatively little is known about the effects of inhalational agents (e.g. isoflurane) upon fetal cerebral oxygen status. By extension, one could propose that regional techniques (e.g. epidermal anesthesia) might have reduced fetal effects because of the localization of anesthetic to the maternal CNS. However, this benefit could be counter-acted by the maternal hypotension and with respect to fetal effects, is the impracticability of measuring oxygen levels. To that end, we are developing a means (near infrared spectroscopy; NIRS) of continually measuring in utero fetal cerebral oxygenation in pregnant sheep. An NIRS device was designed specifically for in utero animal experimentation. Currently, we have validated our NIRS methodology by measuring changes in fetal sheep cerebral oxygenation in response to systemic decreases in oxygen levels produced by umbilical cord occlusion. With the present proposal, we plan to further optimize our technology by applying it to answer a clinically-relevant question: Does maternal anesthesia alter fetal cerebral oxygenation? Completion of this study will yield new information regarding the effects of maternal anesthesia on fetal cerebral oxygenation and well-being. In addition, this research will produce clinically relevant data that will be of significant interest to anesthesiologists, obstetricians, and general surgeons who are presented parturients with fetal or abdominal distress. It is expected that the results of these studies will be used to further develop and refine standards of care for anesthetic use during pregnancy. These results will also validate our NIRS methodology, and will allow us to refine-optimize the technology and to develop the appropriate analysis tools to quantitatively evaluate the resultant NIRS data. Finally, the results will serve as the basis for a long-term outcome study designed to identify the optimal anesthetic parameters to be used during an episode of fetal distress, maternal surgery, and eventually fetal surgery.

这种探索性/发育赠款的目的是使用新技术来确定和区分母体全身麻醉对区域麻醉对胎儿脑氧合的影响。在妊娠女性的操作过程中，维持足够的氧气和养分为胎儿大脑至关重要。盛行的医学实践鼓励将全身麻醉用于非刺激性相关手术和新兴剖宫产部分。但是，对吸入剂（例如异氟烷）对胎儿脑氧状况的影响相对较少。从扩展过程中，人们可以提出，由于麻醉剂将麻醉剂定位于母体中枢神经系统，区域技术（例如表皮麻醉）可能会降低胎儿作用。但是，这种益处可以通过母体低血压来抵消，并且在胎儿的影响方面是测量氧气水平的不切实际性。为此，我们正在开发一种在孕妇的子宫胎儿大脑氧合中不断测量的手段（近红外光谱； NIR）。 NIRS设备是专门为子宫动物实验设计的。目前，我们已经通过测量脐带闭塞产生的氧气水平的全身性降低来测量胎儿绵羊脑充氧的变化来验证我们的NIRS方法论。通过本提案，我们计划通过应用技术来进一步优化我们的技术以回答与临床上的问题：母体麻醉是否改变了胎儿的脑氧合？这项研究的完成将产生有关母体麻醉对胎儿脑充氧和福祉的影响的新信息。此外，这项研究将产生与胎儿或腹部困扰的分娩者有关的麻醉学家，产科医生和普通外科医生的临床相关数据。预计这些研究的结果将用于进一步发展和完善妊娠期间麻醉的护理标准。这些结果还将验证我们的NIRS方法论，并使我们能够完善技术并开发适当的分析工具来定量评估所得的NIRS数据。最后，结果将作为一项长期结局研究的基础，旨在确定在胎儿遇难，孕产妇手术以及最终胎儿手术期间使用的最佳麻醉参数。

项目成果

Maternal and preterm fetal sheep responses to dexmedetomidine.

• DOI: 10.1016/j.ijoa.2012.06.010
• 发表时间: 2012-10
• 期刊: International journal of obstetric anesthesia
• 影响因子: 2.8
• 作者: Uemura K;Shimazutsu K;McClaine RJ;McClaine DJ;Manson RJ;White WD;Benni PB;Reynolds JD
• 通讯作者: Reynolds JD

A description of the preterm fetal sheep systemic and central responses to maternal general anesthesia.

早产胎羊对母体全身麻醉的全身和中枢反应的描述。

• DOI: 10.1213/01.ane.0000252459.43933.59
• 发表时间: 2007
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: McClaine,RebeccaJ;Uemura,Kenichiro;McClaine,DeborahJ;Shimazutsu,Kazufumi;delaFuente,SebastianG;Manson,RobertoJ;White,WilliamD;Eubanks,WilliamS;Benni,PaulB;Reynolds,JamesD
• 通讯作者: Reynolds,JamesD