Maternal-Fetal Cerrahide Anestezi Uygulamaları

Fetal cerrahi anne ve fetal hastayı ilgilendirdiği için fetal-maternal cerrahi olarak adlandırılabilir. Fetusun tedavisi için fizyolojik özellikleri birbirinden farklı iki hastaya anestezi uygulanmaktadır. Fetal cerrahide anestezi uygulamaları doğum ve pediatrik anestezi eğitimi ile farklı disiplinlerin beraber çalışmasını gerektirir. Anestezik ajanların gelişen beyin dokusuna nörotoksik etkileri üzerine ileri araştırmalar devam etmektedir. Ağrılı uyaranlara bağlı olarak fetusun gelişen sinir sistemindeki değişikliklerin uzun dönem etkileri olduğu bilinmektedir. Fetal cerrahi işlemler midgestasyon intrapartum cerrahiler, minimal invaziv girişimler, ve ex utero intrapartum tedaviler EXIT olmak üzere üç grupta toplanır. Anestezi teknikleri, lokal anestezi ve sedasyondan, genel anestezi ve nöroaksiyel anesteziye kadar değişebilir. Cerrahi teknik, anne fetus için risk fayda dengesi, ve önceliklş gereksinimler optimal anestezi planının yapılmasında önemlidir.Bu derlemede; gebedeki fizyolojik değişikliler, fetusun anestezi açısından fizyolojik özellikleri, etik konular, anestezinin fetusa etkileri, cerrahi tekniklere göre anestezi ugulamaları gözden geçirilecektir.

Anahtar Kelimeler:

Fetal cerrahi, anestezi

Anesthesia For Maternal – Fetal Surgery

Fetal surgery is performed on pregnant patient and fetal patient and could be called maternal-fetal surgery. Surgery is on the pregnant women for fetal benefit and anesthesia is necessary for these two patients whose physilogic characteristics are extremly different. Providing anesthesia for fetal surgery necessitates integration of obstetric and pediatric anesthesia integration and many disciplines colloboration and cooperation. The researches are going on about the possibility of anesthetic drugs neurotoxicity on developing nervous system of fetus. The fetus reacts to painfull stimuli and these painfull interventions may cause long term effects . Fetal surgery issues are, minimally invazive interventions, open midgestation surgery and EXIT procedures. An anesthetic plan can range from local anesthetic infiltration to sedation to neuroaxial or general anesthesia. Surgical technique, risk and benefit ratio and potential need are important for optimal anesthetic plan.In this article, we reviewed the maternal physiology, fetal physiology, ethic issues, anesthetics effects on the fetus, anesthetic managements for different types of surgical techniques.

Keywords:

Fetal surgery, anesthesia,

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