Effect of decreased fetal perfusion on placental clearance of volatile anesthetics in a dual perfused human placental cotyledon model
Effect of decreased fetal perfusion on placental clearance of volatile anesthetics in a dual perfused human placental cotyledon model
复制标题
双灌注人胎盘子叶模型中胎儿灌注减少对挥发性麻醉剂胎盘清除的影响
DOI：
10.1007/s00540-013-1777-3
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发表时间：
2014
影响因子：
2.8
通讯作者：
Chikara Tashiro
中科院分区：
文献类型：
--
作者：
Ryusuke Ueki;Tsuneo Tatara;Nobutaka Kariya;Noriko Shimode;Munetaka Hirose;Chikara Tashiro
在全身麻醉下剖宫产术中，吸入麻醉药的胎盘转移是处理胎儿窘迫的关键问题。使用从接受择期剖宫产术的产妇（n= 5）获得的双灌注人胎盘子叶，我们研究了胎儿灌注减少对七氟烷和异氟烷胎盘清除率的影响。保持母体流速固定，胎儿流速从3 ml/min（对照灌注）连续降低至2 ml/min（中间灌注）和1 ml/min（低灌注）。通过胎盘对麻醉剂的清除率评估胎盘转移，胎盘清除率由胎儿静脉和母体动脉中麻醉剂浓度的比值乘以胎儿血流速率定义。比较了不同胎儿灌注状态和麻醉剂之间的胎盘清除率。与对照组（P= 0.002，P < 0.001）和中等灌注组（P= 0.04，P = 0.018）相比，低灌注组七氟醚和异氟醚的清除率较低。在对照灌注（P= 0.93）、中间灌注（P= 1.00）和低灌注（P= 0.88）期间，七氟烷和异氟烷的清除率相当。因此，当紧急剖宫产时观察到胎儿窘迫时，维持挥发性麻醉剂在低浓度可能是不必要的，因为挥发性麻醉剂的胎盘转移随着胎儿灌注的减少而减少。
Placental transfer of volatile anesthetics is a critical issue in managing fetal distress during cesarean section under general anesthesia. Using dual perfused human placental cotyledons obtained from parturients undergoing elective cesarean section (n= 5), we investigated the effect of decreased fetal perfusion on placental clearance of sevoflurane and isoflurane. Keeping the maternal flow rate fixed, fetal flow rate was consecutively decreased from 3 ml/min (control perfusion) to 2 ml/min (intermediate perfusion) and to 1 ml/min (hypoperfusion). Placental transfer was assessed by the clearance of anesthetics by the placenta, defined by the ratio of anesthetic concentration in fetal vein and maternal artery, multiplied by fetal flow rate. Placental clearance was compared between different fetal perfusion states and anesthetics. Hypoperfusion resulted in a lower clearance of sevoflurane and isoflurane compared with control (P= 0.002,P< 0.001) and intermediate (P= 0.04,P= 0.018) perfusion. Clearances of sevoflurane and isoflurane were comparable during control perfusion (P= 0.93), intermediate perfusion (P= 1.00), and hypoperfusion (P= 0.88). Thus, maintenance of volatile anesthetics at a marginally low concentration may not be necessary when fetal distress is observed during emergency cesarean delivery because placental transfer of volatile anesthetics decreases with decreasing fetal perfusion.