Anesthesia for Fetal Surgery

Question 1

_____ _____ ______ are the leading cause of mortality from birth defects and occur in approximately 1% of live births

Answer 1

Congenital heart abnormalities

Question 2

Fetal surgeries do not affect future fertility true or false?

Answer 2

true

Question 3

The fetal risks of intrauterine surgery remains _____

Answer 3

relatively high

Question 4

Who’s safety is most important?

Answer 4

Mother’s

Question 5

Fetal surgery involves _ ______and the anesthesia provider must balance the needs of both

Answer 5

2 patients

Question 6

With maternal administration of general anesthesia _____ ______ _____ readily cross the placenta to the fetus

Answer 6

volatile anesthetic agents

Question 7

Evidence for _______ _______in the developing brain after exposure to a wide range of anesthetic agents such as halogenated agents, propofol, and benzodiazepines, has since shown similar effects. It is not known if anesthetic agents similarly affect human fetuses or neonates.

Answer 7

neuronal apoptosis

Question 8

Regulation of Fetal Heart Rate

Answer 8

Parasympathetic outflow by means of the vagus nerve decreases the FHR
Sympathetic activity increases FHR and cardiac output
Baroreceptors respond to increased blood pressure and chemoreceptors respond to decreased PaO2 to modulate the FHR through the autonomic nervous system.
Cerebral cortical activity and hypothalamic activity affect the FHR through their effects on integrative centers in the medulla oblongata.

Question 9

Fetal Heart Rate

Answer 9

Term fetuses have a lower baseline FHR than preterm fetuses
Studies show that bradycardia (caused by increased vagal activity) is the initial fetal response to acute hypoxemia
Baseline feta heart rate is defined as 110 to 160 beats per minute (bpm)
After prolonged hypoxemia the fetus may experience tachycardia as a result of catecholamine secretion and sympathetic nervous system activity
The following features of the FHR can be assessed: Baseline, variability , accelerations, decelerations
Their association with uterine contraction
External and internal techniques can be used to assess the FHR and uterine contraction. Both external and internal methods, allow continuous assessment of the FHR
The FHR is superimposed over the uterine contraction pattern.
Uterine contraction can be monitored externally with a tocodynamometer (device used to measure the frequency and duration of uterine contractions.