MATERNAL ANESTHESIA AND FETAL CEREBRAL OXYGENATION

产妇麻醉和胎儿脑氧合

• 批准号: 6418500
• 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 2003-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6418500
• 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.

这项探索性/发展性资助的目标是使用新技术来确定和区分母体全身麻醉与区域麻醉对胎儿脑氧合的影响。在妊娠女性的操作过程中，维持胎儿大脑的充足氧气和营养供应是至关重要的。普遍的医疗实践鼓励使用全身麻醉的程序，如非产科相关的手术和紧急剖宫产。然而，关于吸入剂（如异氟烷）对胎儿脑氧状态的影响，我们知之甚少。通过扩展，可以提出局部技术（例如表皮麻醉）可能会减少胎儿效应，因为麻醉剂定位于母体CNS。然而，这种益处可能会被母体低血压抵消，并且对于胎儿的影响，测量氧气水平是不可行的。为此，我们正在开发一种方法（近红外光谱法; NIRS）连续测量子宫内胎儿脑氧合在怀孕的绵羊。NIRS装置专门设计用于子宫内动物实验。目前，我们已经验证了我们的近红外光谱方法，通过测量胎羊脑氧合的变化，以响应脐带闭塞产生的氧气水平的全身性下降。根据目前的建议，我们计划通过应用该技术来回答一个临床相关问题来进一步优化我们的技术：母体麻醉是否会改变胎儿脑氧合？这项研究的完成将产生关于母体麻醉对胎儿脑氧合和健康影响的新信息。此外，这项研究将产生临床相关数据，这将是显着的兴趣，麻醉师，产科医生和普通外科医生谁是产妇与胎儿或腹部窘迫。预计这些研究的结果将用于进一步制定和完善妊娠期间麻醉剂使用的护理标准。这些结果也将验证我们的近红外光谱方法，并将使我们能够完善优化技术，并开发适当的分析工具，以定量评估所产生的近红外光谱数据。最后，研究结果将作为一项长期结局研究的基础，该研究旨在确定在胎儿窘迫、母体手术和最终胎儿手术期间使用的最佳麻醉参数。