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Anesth Analg 2007;104:397-406
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000252459.43933.59

OBSTETRIC ANESTHESIA

A Description of the Preterm Fetal Sheep Systemic and Central Responses to Maternal General Anesthesia

Rebecca J. McClaine, MD*, Kenichiro Uemura, MD{dagger}, Deborah J. McClaine, BS*, Kazufumi Shimazutsu, MD*, Sebastian G. de la Fuente, MD{dagger}, Roberto J. Manson, MD{dagger}, William D. White, MPH*, William S. Eubanks, MD{ddagger}, Paul B. Benni, PhD§, and James D. Reynolds, PhD*{dagger}

From the Departments of *Anesthesiology and {dagger}Surgery, Duke University Medical Center, Durham, North Carolina; {ddagger}Department of Surgery, University of Missouri-Columbia, Columbia, Missouri; and §CAS Medical Systems, Incorporated, Branford, Connecticut.

Address correspondence and reprint requests to James D. Reynolds, PhD, Departments of Anesthesiology and Surgery, Research Director, Division of Women's Anesthesia, Duke University Medical Center, Durham, NC 27710. Address e-mail to reyno010{at}mc.duke.edu.

BACKGROUND: The second trimester is recommended as the optimal time to conduct a surgical procedure on pregnant patients, even though the fetal responses to anesthesia at this age are not known. Here we assessed the responses of preterm fetal sheep to a standard anesthetic regimen of midazolam, thiopental, and isoflurane.

METHODS: Variables were monitored in previously instrumented preterm pregnant sheep before, during, and after 4 h of general anesthesia. Isoflurane produced moderate fetal hypotension and bradycardia, whereas extubation was accompanied by increases in fetal heart rate and mean arterial blood pressure.

RESULTS: We observed an initial increase in fetal Sao2 followed by a gradual decline to baseline. Within the fetal brain, oxygenated hemoglobin changed by <10% (nonsignificant) and deoxygenated hemoglobin and total hemoglobin varied by <5%. Overall, although O2 levels within the preterm fetal brain were not independently enhanced by isoflurane (as occurs in the older fetus and in the adult), they did remain constant even as fetal mean arterial pressure decreased by more than 20%. By extension, we failed to identify changes in cerebral oxygenation that could be construed as injurious.

CONCLUSION: Any adverse preterm fetal response to maternal surgery should not be attributed solely to the actions of general anesthesia upon the fetus.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.