Turkiye Klinikleri Journal of Anesthesiology Reanimation

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Fetal Girişimlerde Maternal-Fetal Anestezi/Analjezi: Geleneksel Derleme
Maternal-Fetal Anesthesia/Analgesia in Fetal Interferences: Traditional Review
Onur ÖZLÜa
aTOBB Ekonomi ve Teknoloji Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon ABD, Ankara, TÜRKİYE
Turkiye Klinikleri J Anest Reanim. 2021;19(3):140-50
doi: 10.5336/anesthe.2021-85460
Article Language: TR
Full Text
ÖZET
 Fetal cerrahi, klinik araştırmaların beraberinde inovatif çalışmalarla hızla gelişen, disiplinler arasında karşılıklı iş birliğinin zorunlu olduğu, etiğin temel bileşen olduğu bir disiplindir. Pediatrik ve obstetrik anestezi uygulamalarının bütünleşmesini gerektirir. Gebe hasta ve fetüs olmak üzere 2 hasta vardır, fetüsün iyiliği için 2 hastaya anestezi uygulanır ve hata yapma aralığı çok dardır. Fetal cerrahi minimal invaziv işlemlerden, açık cerrahi işlemlere kadar geniş aralığa dağılır. Minimal invaziv işlemler genellikle hafif sedasyon ve lokal anestezi ile yapılır, nadiren nöroaksiyel anestezi ve genel anestezi gerekir. Ultrasonografi kılavuzluğunda yapılan perkütan girişimler eş zamanlı ultrasonografi ile görüntülenirken, perkütan uygulanan fetoskopik kameralar kılavuzluğunda fetal endoskoplarla cerrahi gerçekleştirilir. Fetal ekokardiyografi, umbilikal kordun Doppler ultrasonografisi, fetal puls oksimetri uygulamaları temel fetus monitorizasyon metodlarıdır. Cerrahi işlem sırasında mutlaka fetal analjezi uygulanmalıdır. Açık işlemler anne genel anestezi altında iken uygulanır. Açık işlemlerde fetal kardiyak fonksiyonlar izlenmeli, uterus gevşemesi, uteroplasental perfüzyonun devamı sağlanmalıdır. Fetüs, uterus kavitesine döner ve gelişimine devam eder. Ex utero intrapartum cerrahiler, sezaryen ameliyatlarının modifikasyonudur, plasenta desteği devam ederken, fetüsün uterus dışında yaşamını sürdürmesini sağlayacak cerrahi işlemler uygulanır. Bebek doğduktan sonra tokoliz sonlandırılarak, uterusun kasılması sağlanır. Ameliyathanede yenidoğanı karşılayacak 2. bir cerrahi ekibin bulunması gerekebilir. Bu derlemede, maternal-fetal cerrahide etik yaklaşım, preoperatif hazırlık, fetal cerrahi girişimler, fetüsün analjezi ve anestezisi, annenin anestezisi, fetüsün monitörizasyonu gözden geçirilmektedir.

Anahtar Kelimeler: Fetal anestezi; fetal cerrahi; obstetrik anestezi
ABSTRACT
 Fetal surgery is a discipline that develops rapidly with clinical researches and innovative studies, mutual cooperation between disciplines is obligatory, and ethics is one of the main components. It requires the integration of pediatric and obstetric anesthesia. There are 2 patients, a pregnant patient and a fetus, 2 patients are anesthetized for the sake of the fetus, and the error range is very narrow. Fetal surgery ranges from minimally invasive procedures to open surgical procedures. Minimally invasive procedures are usually performed with mild sedation and local anesthesia, rarely neuraxial anesthesia and general anesthesia are required. These are percutaneous interventions under ultrasound guidance or surgery is performed with fetal endoscopes under the guidance of percutaneously applied fetoscopic cameras, while simultaneous ultrasound imaging. Fetal echocardiography, Doppler ultrasonography of umbilical cord, fetal pulsoximetry are the basic fetal monitorings. Open procedures are performed while the mother is under general anesthesia. Fetal cardiac monitoring, uterine relaxation and continuation of uteroplacental perfusion. Fetal analgesia should be ensured during surgical procedures. Conclusion of intervention the fetus returns to the uterine cavity and continues its development. Ex utero intrapartum surgeries are modifications of cesarean sections. While the placental support continues, surgical procedures are applied to ensure the fetus to survive outside the uterus. After the delivery, tocolysis is terminated and the uterus is contracted. A 2nd surgical team should be in the operating room to evaluates the neonate and acts according to the neonate's requirements at birth in some cases. In this review, ethical approach, preoperative preparation, surgical interventions, fetal analgesia and anesthesia, maternal anesthesia, fetal monitoring are reviewed.

Keywords: Fetal surgery; fetal anesthesia; obstetric anesthesia
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