Best practice & research. Clinical anaesthesiology
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Research in fetal surgery is currently ethically controversial, especially because it poses risks to both the fetus and the pregnant woman. We provide an ethical framework for fetal surgery research based on the concept of the fetus as a patient. This framework results in criteria for preliminary investigation of new fetal surgery techniques, for the initiation and termination of clinical trials, the informed consent process, inclusion or exclusion of women based on abortion preferences and the obligations of physicians to refer patients to fetal research protocols. We demonstrate the applicability of this framework to fetal surgery research for spina bifida, a common fetal anomaly.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewFetal endoscopic surgery: indications and anaesthetic management.
Fetal intervention for certain life-threatening conditions has progressed from being primarily experimental in nature to the standard of care in certain circumstances. While surgical techniques have advanced over the past few years, the anaesthetic goals for these interventions have remained the same; namely, minimizing maternal and fetal risk as well as maximizing the chances of a successful fetal intervention and optimize the conditions necessary to carry the fetus to term gestation. ⋯ This chapter will address the fetal diseases that may benefit from fetoscopic intervention, the rationale behind why maternal and fetal anaesthesia is required, the various anaesthetics used for these cases and specific considerations of both maternal and fetal physiology that aid in the determination of the best anaesthetic technique for individual cases. Methods of intra-operative fetal monitoring and fetal resuscitation will also be discussed.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewPain, opioid tolerance and sensitisation to nociception in the neonate.
Pain is commonplace in newborn infants. Opioid analgesics have become increasingly used to reduce different types of pain in neonates, including pain from surgery, medical procedures and chronic conditions. ⋯ These adverse effects can be minimised by utilising specific administration techniques and constant monitoring. Recent studies have demonstrated that untreated pain can have long-term effects on infant pain behaviours months beyond the events, thus, opioid analgesics may have a beneficial role that extends beyond the immediate painful event(s).
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It is not known if the fetus can actually feel pain, but noxious stimulation during fetal life does cause detectable stress responses. These responses cause both short and long-term changes in the central nervous system, which can affect subsequent pain behaviour. ⋯ However, the optimal amount of suppression required and the best method of achieving this (opioid or regional anaesthesia techniques) remain unknown. Prevention and treatment of pain is a basic human right, regardless of age, and if the technique of fetal surgery is to progress then a greater understanding of nociception and the stress response is required.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewMajor abdominal surgery of the neonate: anaesthetic considerations.
The anaesthetic handling of neonates scheduled for major abdominal surgical procedures is one of the most demanding tasks that can confront an anaesthesiologist. This chapter will review the specific physiological characteristics of the newborn with relevance to anaesthesia and will also provide robust guidelines for the anaesthetic handling of the most frequent diagnoses that need major abdominal surgery during the neonatal period.