PDF(Pubmed)
Abstract：
UNASSIGNED: The anesthetic management of fetal operative procedures (FOP) is a highly debated topic. Literature on fetal pain perception and response to external stimuli is rapidly expanding. Nonetheless, there is no consensus on the fetal consciousness nor on the instruments to measure pain levels. As a result, no guidelines or clinical recommendations on anesthesia modality during FOP are available. This systematic literature review aimed to collect the available knowledge on the most common fetal interventions, and summarize the reported outcomes for each anesthetic approach. Additional aim was to provide an overall evaluation of the most commonly used anesthetic agents.
UNASSIGNED: Two systematic literature searches were performed in Embase, Medline, Web of Science Core Collection and Cochrane Central Register of Controlled Trials up to December 2021. To best cover the available evidence, one literature search was mostly focused on fetal surgical procedures; while anesthesia during FOP was the main target for the second search. The following fetal procedures were included: fetal transfusion, laser ablation of placental anastomosis, twin-reversed arterial perfusion treatment, fetoscopic endoluminal tracheal occlusion, thoraco-amniotic shunt, vesico-amniotic shunt, myelomeningocele repair, resection of sacrococcygeal teratoma, ligation of amniotic bands, balloon valvuloplasty/septoplasty, ex-utero intrapartum treatment, and ovarian cyst resection/aspiration. Yielded articles were screened against the same inclusion criteria. Studies reporting anesthesia details and procedures\' outcomes were considered. Descriptive statistical analysis was performed and findings were reported in a narrative manner.
UNASSIGNED: The literature searches yielded 1,679 articles, with 429 being selected for full-text evaluation. A total of 168 articles were included. Overall, no significant differences were found among procedures performed under maternal anesthesia or maternal-fetal anesthesia. Procedures requiring invasive fetal manipulation resulted to be more effective when performed under maternal anesthesia only. Based on the available data, a wide range of anesthetic agents are currently deployed and no consistency has been found neither between centers nor procedures.
UNASSIGNED: This systematic review shows great variance in the anesthetic management during FOP. Further studies, systematically reporting intraoperative fetal monitoring and fetal hormonal responses to external stimuli, are necessary to identify the best anesthetic approach. Additional investigations on pain pathways and fetal pain perception are advisable.
UNASSIGNED: Two systematic literature searches were performed in Embase, Medline, Web of Science Core Collection and Cochrane Central Register of Controlled Trials up to December 2021. To best cover the available evidence, one literature search was mostly focused on fetal surgical procedures; while anesthesia during FOP was the main target for the second search. The following fetal procedures were included: fetal transfusion, laser ablation of placental anastomosis, twin-reversed arterial perfusion treatment, fetoscopic endoluminal tracheal occlusion, thoraco-amniotic shunt, vesico-amniotic shunt, myelomeningocele repair, resection of sacrococcygeal teratoma, ligation of amniotic bands, balloon valvuloplasty/septoplasty, ex-utero intrapartum treatment, and ovarian cyst resection/aspiration. Yielded articles were screened against the same inclusion criteria. Studies reporting anesthesia details and procedures\' outcomes were considered. Descriptive statistical analysis was performed and findings were reported in a narrative manner.
UNASSIGNED: The literature searches yielded 1,679 articles, with 429 being selected for full-text evaluation. A total of 168 articles were included. Overall, no significant differences were found among procedures performed under maternal anesthesia or maternal-fetal anesthesia. Procedures requiring invasive fetal manipulation resulted to be more effective when performed under maternal anesthesia only. Based on the available data, a wide range of anesthetic agents are currently deployed and no consistency has been found neither between centers nor procedures.
UNASSIGNED: This systematic review shows great variance in the anesthetic management during FOP. Further studies, systematically reporting intraoperative fetal monitoring and fetal hormonal responses to external stimuli, are necessary to identify the best anesthetic approach. Additional investigations on pain pathways and fetal pain perception are advisable.
摘要：
未经授权：胎儿手术程序（FOP）的麻醉管理是一个备受争议的话题。关于胎儿疼痛感知和对外部刺激的反应的文献正在迅速扩大。尽管如此，在胎儿意识和测量疼痛程度的仪器上没有达成共识。因此,目前尚无关于FOP期间麻醉方式的指南或临床建议.这篇系统的文献综述旨在收集有关最常见的胎儿干预措施的可用知识。并总结每种麻醉方法的报告结果。另外的目的是提供最常用的麻醉剂的总体评估。
UNASSIGNED：在Embase中进行了两次系统的文献检索，Medline,截至2021年12月，WebofScience核心合集和Cochrane中央对照试验登记册。为了最好地掩盖现有的证据，一次文献检索主要集中在胎儿外科手术;而FOP期间的麻醉是第二次检索的主要目标.包括以下胎儿程序：胎儿输血，激光切除胎盘吻合术，双逆转动脉灌注治疗，胎儿镜下腔内气管闭塞，胸羊膜分流术,膀胱羊膜分流术,脊髓膜膨出修复,骶尾部畸胎瘤切除术，羊膜带结扎，球囊瓣膜成形术/鼻中隔成形术,子宫外产时治疗，和卵巢囊肿切除/抽吸术。根据相同的纳入标准筛选出的文章。考虑了报告麻醉细节和手术结果的研究。进行描述性统计分析，并以叙述方式报告发现。
未经评估：文献检索产生了1,679篇文章，选择429进行全文评估。共纳入168篇文章。总的来说,在母体麻醉或母胎麻醉下进行的手术间无显著差异.仅在母体麻醉下进行需要侵入性胎儿操作的程序会更有效。根据现有数据，目前使用的麻醉药种类繁多,在中心和程序之间均未发现一致性.
UNASSIGNED：本系统评价显示FOP期间麻醉管理存在很大差异。进一步研究,系统地报告术中胎儿监测和胎儿对外界刺激的激素反应，有必要确定最佳的麻醉方法。建议对疼痛途径和胎儿疼痛感知进行其他调查。
UNASSIGNED：在Embase中进行了两次系统的文献检索，Medline,截至2021年12月，WebofScience核心合集和Cochrane中央对照试验登记册。为了最好地掩盖现有的证据，一次文献检索主要集中在胎儿外科手术;而FOP期间的麻醉是第二次检索的主要目标.包括以下胎儿程序：胎儿输血，激光切除胎盘吻合术，双逆转动脉灌注治疗，胎儿镜下腔内气管闭塞，胸羊膜分流术,膀胱羊膜分流术,脊髓膜膨出修复,骶尾部畸胎瘤切除术，羊膜带结扎，球囊瓣膜成形术/鼻中隔成形术,子宫外产时治疗，和卵巢囊肿切除/抽吸术。根据相同的纳入标准筛选出的文章。考虑了报告麻醉细节和手术结果的研究。进行描述性统计分析，并以叙述方式报告发现。
未经评估：文献检索产生了1,679篇文章，选择429进行全文评估。共纳入168篇文章。总的来说,在母体麻醉或母胎麻醉下进行的手术间无显著差异.仅在母体麻醉下进行需要侵入性胎儿操作的程序会更有效。根据现有数据，目前使用的麻醉药种类繁多,在中心和程序之间均未发现一致性.
UNASSIGNED：本系统评价显示FOP期间麻醉管理存在很大差异。进一步研究,系统地报告术中胎儿监测和胎儿对外界刺激的激素反应，有必要确定最佳的麻醉方法。建议对疼痛途径和胎儿疼痛感知进行其他调查。
