Neurodevelopmetal effects of maternal blood pressure management with noradrenaline during general anaesthesia for nonobstetric surgery in the pregnant rabbit model
Neurodevelopmetal effects of maternal blood pressure management with noradrenaline during general anaesthesia for nonobstetric surgery in the pregnant rabbit model
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DOI：
10.1097/eja.0000000000001681
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发表时间：
2022-06-01
影响因子：
3.6
通讯作者：
Rex, Steffen
中科院分区：
文献类型：
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作者：
Bleeser, Tom;van der Veeken, Lennart;Rex, Steffen
背景在孕妇中，麻醉引起的低血压通常使用去甲肾上腺素或去甲肾上腺素来治疗，其基本原理是维持子宫灌注压，从而维持子宫血流。在非产科手术的全身麻醉过程中，缺乏这一策略的证据。目的分析去甲肾上腺素治疗麻醉性低血压对非产科手术全麻下母兔胎脑发育的影响。我们假设母体低血压的治疗会改善胎儿结局。设计随机对照实验室研究，选用妊娠28天的21只怀孕兔(DO)。干预：七氟醚麻醉2小时用于开腹手术，不治疗麻醉性低血压(低血压组)或使用去甲肾上腺素维持母亲平均动脉压在苏醒值的80%以上(去甲肾上腺素组)。在对照组中，DOS保持不变。在足月，所有的幼崽都是通过剖腹产出生的。一天后，对幼崽的神经行为进行了评估，并采集了大脑。主要结果去甲肾上腺素组与低血压组比较额叶皮质神经元密度是主要结果；神经行为评分和其他组织学结果是次要结果。结果去甲肾上腺素组和降压组额叶皮质神经元密度相似(1181+/-162vs1189+/-200个神经元mm(-2)，P=0.870)。然而，与低血压组相比，去甲肾上腺素组的胎儿存活率显著降低，神经行为评估中的感觉评分较低，细胞增殖也较少。其他区域的神经元密度、总细胞密度、生物计量学和突触发生没有受到影响。对照组与低血压组比较差异无统计学意义。结论在兔非产科手术的全麻过程中，使用去甲肾上腺素治疗麻醉性低血压并不影响神经元密度，但根据几个次要结局参数与胎儿结局受损有关。需要进一步的研究来调查是否与临床相关，并确定孕妇在全身麻醉期间的目标血压。
BACKGROUND In pregnant women, anaesthesia-induced hypotension is commonly treated using phenylephrine or noradrenaline, the rationale being to maintain uterine perfusion pressure and thereby uterine blood flow. Evidence for this strategy during general anaesthesia for nonobstetric surgery is absent. OBJECTIVE To analyse the effects of treating anaesthesia-induced hypotension with noradrenaline on brain development of rabbit foetuses of mothers subjected to general anaesthesia for nonobstetric surgery. We hypothesised that treatment of maternal hypotension would improve foetal outcomes. DESIGN Randomised controlled laboratory study using 21 pregnant rabbits (does) at 28 days of gestation. INTERVENTION Two hours of sevoflurane anaesthesia for a laparotomy without treatment of anaesthesia-induced hypotension (hypotension group) or with maintaining maternal mean arterial pressure above 80% of the awake value using noradrenaline (noradrenaline group). In the control group, does remained untouched. At term, all pups were delivered by caesarean section. One day later, the neurobehaviour of the pups was assessed and brains were harvested. MAIN OUTCOMES Neuron density in the frontal cortex for the comparison of noradrenaline groups versus hypotension groups was the primary outcome; the neurobehavioural scores and other histological outcomes were secondary outcomes. RESULTS In the noradrenaline groups and hypotension groups, neuron density in the frontal cortex was similar (1181 +/- 162 versus 1189 +/- 200 neurons mm(-2), P = 0.870). However, significantly less foetal survival, lower sensory scores in neurobehavioural assessment and less proliferation were observed in the noradrenaline group when compared with the hypotension group. Neuron densities in other regions, total cell densities, biometrics and synaptogenesis were not affected. There were no differences between the control group and hypotension group. CONCLUSION During general anaesthesia for nonobstetric surgery in rabbits, treatment of anaesthesia-induced hypotension using noradrenaline did not affect neuron densities but was associated with impaired foetal outcomes according to several secondary outcome parameters. Further studies are needed to investigate any clinical relevance and to determine the target blood pressure in pregnant women during general anaesthesia.