Abstract：
This review describes an in-depth analysis of the neurotoxicity associated with the anesthetic agents used during fetal surgery, intending to highlight the importance of understanding the effects of general anesthetics on the developing brain, particularly in the context of open fetal surgery, where high doses are applied to facilitate surgical access and augment uterine relaxation. We examined evidence from preclinical studies in rodents and primates, along with studies in human subjects, with the results collectively suggesting that general anesthetics can disrupt brain development and lead to long-lasting neurological deficits. Our review underscores the clinical implications of these findings, indicating an association between extensive anesthetic exposure in early life and subsequent cognitive deficits. The current standard of anesthetic care for fetal surgical procedures was scrutinized, and recommendations have been proposed to mitigate the risk of anesthetic neurotoxicity. These recommendations emphasize the need for careful selection of anesthetic techniques to minimize fetal exposure to potentially harmful agents. In conclusion, while the benefits of fetal surgery in addressing immediate risks often outweigh the potential neurotoxic effects of anesthesia, the long-term developmental impacts nevertheless warrant consideration. Our analysis suggests that the use of general anesthetics in fetal surgery, especially at high doses, poses a significant risk of developmental neurotoxicity. As such, it is imperative to explore safer alternatives, such as employing different methods of uterine relaxation and minimizing the use of general anesthetics, to achieve the necessary surgical conditions. Further research, particularly in clinical settings, is essential to fully understand the risks and benefits of anesthetic techniques in fetal surgery.
摘要：
这篇综述描述了与胎儿手术过程中使用的麻醉剂相关的神经毒性的深入分析。旨在强调了解全身麻醉药对发育中的大脑的影响的重要性，特别是在胎儿开放性手术中，其中高剂量应用于促进手术进入和增加子宫松弛。我们检查了啮齿动物和灵长类动物临床前研究的证据，随着人类受试者的研究，结果共同表明全身麻醉药可以破坏大脑发育并导致长期的神经功能缺损。我们的评论强调了这些发现的临床意义，表明生命早期广泛的麻醉剂暴露与随后的认知缺陷之间存在关联。对胎儿外科手术麻醉护理的现行标准进行了审查，并提出了降低麻醉神经毒性风险的建议。这些建议强调需要仔细选择麻醉技术，以最大程度地减少胎儿对潜在有害物质的暴露。总之,虽然胎儿手术在解决直接风险方面的好处往往超过麻醉的潜在神经毒性作用，然而，长期的发展影响值得考虑。我们的分析表明，在胎儿手术中使用全身麻醉药，尤其是在高剂量下，构成发育神经毒性的重大风险。因此，探索更安全的替代品势在必行，例如采用不同的子宫松弛方法和尽量减少全身麻醉药的使用，达到必要的手术条件。进一步研究,特别是在临床环境中，对于充分了解胎儿手术中麻醉技术的风险和益处至关重要。
