Base de dados : MEDLINE
Pesquisa : E01.370.378.630.300 [Categoria DeCS]
Referências encontradas : 1554 [refinar]
Mostrando: 1 .. 10   no formato [Detalhado]

página 1 de 156 ir para página                         

  1 / 1554 MEDLINE  
              next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29417679
[Au] Autor:Quintero R; Chmait RH
[Ad] Endereço:USFetus Research Consortium, Miami, Los Angeles, USA.
[Ti] Título:Re: Monochorionic diamniotic twin pregnancy with selective fetal growth restriction Type II: sonographic and fetoscopic findings of poor prognosis.
[So] Source:Ultrasound Obstet Gynecol;51(2):280, 2018 02.
[Is] ISSN:1469-0705
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Retardo do Crescimento Fetal
Gravidez de Gêmeos
[Mh] Termos MeSH secundário: Feminino
Transfusão Feto-Fetal
Fetoscopia
Seres Humanos
Gravidez
Prognóstico
Gêmeos Monozigóticos
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1002/uog.18995


  2 / 1554 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29215525
[Au] Autor:Belfort MA; Whitehead WE; Bednov A; Shamshirsaz AA
[Ad] Endereço:Texas Children's Fetal Center and the Departments of Obstetrics and Gynecology and Neurosurgery, Baylor College of Medicine, Houston, Texas.
[Ti] Título:Low-Fidelity Simulator for the Standardized Training of Fetoscopic Meningomyelocele Repair.
[So] Source:Obstet Gynecol;131(1):125-129, 2018 Jan.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Fetoscopic meningomyelocele repair in a gas-filled uterus is a new technique performed in very few centers. There are few opportunities as well as ethical prohibitions on the initial development and subsequent refinement of innovative fetal surgery techniques in humans, and using an animal model is both very expensive and logistically difficult. METHOD: We developed a low-fidelity endoscopic fetal surgery simulation using a plastic doll and pieces of chicken breast to simulate a fetal meningomyelocele, and a polyurethane ball to simulate a gas-filled uterus, along with a standard endoscopy system and instruments. EXPERIENCE: A unique two-port technique with significant differences from the standard laparoscopic surgery procedure was developed and refined through an iterative phase into a standardized methodology, and the simulator was then used to train three other teams to perform standardized fetoscopic meningomyelocele repair. CONCLUSION: A low-fidelity fetoscopic surgery simulator is a useful tool for developing new fetoscopic operations and for training multidisciplinary fetal surgery teams without the need for extensive use of an animal model. This simulator may be used to further explore the human uterus as a new surgical space for additional fetal surgeries.
[Mh] Termos MeSH primário: Competência Clínica
Fetoscopia/educação
Meningomielocele/cirurgia
Procedimentos Neurocirúrgicos/educação
Treinamento por Simulação/métodos
[Mh] Termos MeSH secundário: Simulação por Computador
Feminino
Fetoscopia/métodos
Seres Humanos
Modelos Anatômicos
Procedimentos Neurocirúrgicos/métodos
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002406


  3 / 1554 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28301888
[Au] Autor:Schneck E; Koch C; Arens C; Schürg R; Zajonz T; Khaleeva A; Kohl T; Weigand MA; Sander M
[Ti] Título:Geburtshilfe: Anästhesie bei fetaler Chirurgie..
[So] Source:Anasthesiol Intensivmed Notfallmed Schmerzther;52(3):204-213, 2017 Mar.
[Is] ISSN:1439-1074
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Due to the responsibility for the mother and the unborn child, fetal surgery represents a challenging task for the anesthesiologist. Maternal changes during pregnancy have to be considered as well as the fetal physiology and the surgeon's needs. Main principles of the anesthesiological management of fetal surgery include the stabilization of the mean arterial pressure in order to preserve a sufficient placental blood flow, sustainment of an adequate oxygenation and ventilation as well as thorough temperature surveillance. Since the mothers are at risk for perioperative pulmonary edema, extended hemodynamic monitoring might be necessary. This article presents the principles of fetal surgery, informs about pregnancy-related changes in circulatory and respiratory physiology and contains anesthesiological considerations to this topic.
[Mh] Termos MeSH primário: Anestesia Obstétrica/métodos
Doenças Fetais/cirurgia
Fetoscopia/efeitos adversos
Fetoscopia/métodos
Complicações Cardiovasculares na Gravidez/etiologia
Complicações Cardiovasculares na Gravidez/terapia
[Mh] Termos MeSH secundário: Medicina Baseada em Evidências
Feminino
Doenças Fetais/diagnóstico
Seres Humanos
Gravidez
Complicações Cardiovasculares na Gravidez/diagnóstico
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170317
[St] Status:MEDLINE
[do] DOI:10.1055/s-0042-105989


  4 / 1554 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28281301
[Au] Autor:Gil Guevara E; Pazos A; Gonzalez O; Carretero P; Molina FS
[Ad] Endereço:The Center for Fetal, Cellular and Molecular Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
[Ti] Título:Doppler assessment of patients with twin-to-twin transfusion syndrome and survival following fetoscopic laser surgery.
[So] Source:Int J Gynaecol Obstet;137(3):241-245, 2017 Jun.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate fetal-survival rates following laser surgery for twin-to-twin transfusion syndrome (TTTS) and the impact of Doppler analysis. METHODS: The present retrospective single-center study included data from patients with pregnancies exhibiting TTTS treated with fetoscopic laser surgery between January 1, 2007, and December 31, 2016. Perinatal outcomes were examined and variables were compared between the donor and recipient fetuses that survived and died, respectively. RESULTS: There were 86 pregnancies exhibiting TTTS treated with fetoscopic laser surgery included in the study. The median length of pregnancy at the time of surgery was 21.1 weeks. Both twin fetuses and at least one fetus survived in 61 (71%) and 73 (85%) pregnancies, respectively. Among recipient fetuses, ductus venosus a-wave anomalies (P=0.026), shorter cervical length (P=0.044), and a greater than 25% discrepancy in the estimated weight of the twin fetuses (P=0.045) were associated with reduced survival. CONCLUSION: Among pregnancies exhibiting TTTS, laser surgery was associated with significant dual-fetus survival. Preoperative ductus venosus anomalies were associated with lower survival among recipient fetuses, and 1-week postsurgical ultrasonography data demonstrated lower survival among recipient fetuses with persistent anomalous ductus venosus compared with normalized ductus venosus.
[Mh] Termos MeSH primário: Transfusão Feto-Fetal/diagnóstico por imagem
Transfusão Feto-Fetal/cirurgia
Placenta/cirurgia
[Mh] Termos MeSH secundário: Feminino
Fetoscopia
Seres Humanos
Recém-Nascido
Fotocoagulação a Laser
Placenta/irrigação sanguínea
Placenta/diagnóstico por imagem
Gravidez
Estudos Retrospectivos
Análise de Sobrevida
Ultrassonografia Doppler
Ultrassonografia Pré-Natal
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170311
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12143


  5 / 1554 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28277363
[Au] Autor:Belfort MA; Whitehead WE; Shamshirsaz AA; Bateni ZH; Olutoye OO; Olutoye OA; Mann DG; Espinoza J; Williams E; Lee TC; Keswani SG; Ayres N; Cassady CI; Mehollin-Ray AR; Sanz Cortes M; Carreras E; Peiro JL; Ruano R; Cass DL
[Ad] Endereço:Departments of Obstetrics and Gynecology, Neurosurgery, Surgery, Anesthesiology, Pediatrics, and Radiology, Baylor College of Medicine, and Texas Children's Fetal Center, Houston, Texas; and the Departments of Obstetrics and Gynecology and Surgery, Vall D'Hebron Hospital, Barcelona, Spain.
[Ti] Título:Fetoscopic Open Neural Tube Defect Repair: Development and Refinement of a Two-Port, Carbon Dioxide Insufflation Technique.
[So] Source:Obstet Gynecol;129(4):734-743, 2017 Apr.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To describe development of a two-port fetoscopic technique for spina bifida repair in the exteriorized, carbon dioxide-filled uterus and report early results of two cohorts of patients: the first 15 treated with an iterative technique and the latter 13 with a standardized technique. METHODS: This was a retrospective cohort study (2014-2016). All patients met Management of Myelomeningocele Study selection criteria. The intraoperative approach was iterative in the first 15 patients and was then standardized. Obstetric, maternal, fetal, and early neonatal outcomes were compared. Standard parametric and nonparametric tests were used as appropriate. RESULTS: Data for 28 patients (22 endoscopic only, four hybrid, two abandoned) are reported, but only those with a complete fetoscopic repair were analyzed (iterative technique [n=10] compared with standardized technique [n=12]). Maternal demographics and gestational age (median [range]) at fetal surgery (25.4 [22.9-25.9] compared with 24.8 [24-25.6] weeks) were similar, but delivery occurred at 35.9 (26-39) weeks of gestation with the iterative technique compared with 39 (35.9-40) weeks of gestation with the standardized technique (P<.01). Duration of surgery (267 [107-434] compared with 246 [206-333] minutes), complication rates, preterm prelabor rupture of membranes rates (4/12 [33%] compared with 1/10 [10%]), and vaginal delivery rates (5/12 [42%] compared with 6/10 [60%]) were not statistically different in the iterative and standardized techniques, respectively. In 6 of 12 (50%) compared with 1 of 10 (10%), respectively (P=.07), there was leakage of cerebrospinal fluid from the repair site at birth. Management of Myelomeningocele Study criteria for hydrocephalus-death at discharge were met in 9 of 12 (75%) and 3 of 10 (30%), respectively, and 7 of 12 (58%) compared with 2 of 10 (20%) have been treated for hydrocephalus to date. These latter differences were not statistically significant. CONCLUSION: Fetoscopic open neural tube defect repair does not appear to increase maternal-fetal complications as compared with repair by hysterotomy, allows for vaginal delivery, and may reduce long-term maternal risks. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov, NCT02230072.
[Mh] Termos MeSH primário: Dióxido de Carbono/uso terapêutico
Vazamento de Líquido Cefalorraquidiano
Fetoscopia
Insuflação
Complicações Pós-Operatórias/diagnóstico
Disrafismo Espinal
[Mh] Termos MeSH secundário: Adulto
Vazamento de Líquido Cefalorraquidiano/diagnóstico
Vazamento de Líquido Cefalorraquidiano/etiologia
Pesquisa Comparativa da Efetividade
Feminino
Fetoscopia/efeitos adversos
Fetoscopia/métodos
Idade Gestacional
Seres Humanos
Histerotomia/efeitos adversos
Histerotomia/métodos
Recém-Nascido
Insuflação/efeitos adversos
Insuflação/métodos
Procedimentos Neurocirúrgicos/efeitos adversos
Procedimentos Neurocirúrgicos/métodos
Avaliação de Processos e Resultados (Cuidados de Saúde)
Gravidez
Resultado da Gravidez
Estudos Retrospectivos
Disrafismo Espinal/diagnóstico
Disrafismo Espinal/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
142M471B3J (Carbon Dioxide)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170621
[Lr] Data última revisão:
170621
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000001941


  6 / 1554 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28272225
[Au] Autor:Li Q; Wu XH; Zhang WS
[Ad] Endereço:Department of Obstetrics and Gynecology, Xiang-Ya Hospital, Central South University, Hunan, Changsha, China.
[Ti] Título:A new method for selective reduction in TRAP sequence with a contraindication to fetoscopic surgery: A case report.
[So] Source:Medicine (Baltimore);96(10):e6250, 2017 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: The preferred method for multifetal pregnancy reduction (MFPR) is a transabdominal intrathoracic or intracranial injection of potassium chloride (KCl). However, in monochorionic multiple pregnancies (MMPs), especially in monoamnionic multifetal pregnancies, selective feticide by this method is often associated with miscarriage of the remaining fetuses. Selective fetal reduction in MMPs by blood flow ablation using radiofrequency ablation or fetoscopic laser surgery may improve survival of the remaining fetus. Although often successful, MFPR by these methods is contraindicated in cases of twin reversed arterial perfusion (TRAP) sequence in triplet pregnancies complicated by polyhydramnios or anterior placenta, as it is difficult to locate the ablation target. PATIENT CONCERNS: 2 cases were admitted to Xiangya Hospital, Central South University with triplet pregnancies at 23 or 21weeks of gestation. DIAGNOSES: Case 1 was a 29-year-old woman with a triplet pregnancy in 2 distinct amniotic sacs and 1 fetus with multiple malformations. Case 2 was a 32-year-old woman who was identified as a triplet pregnancy with TRAP sequence with an acardiac/acephalic twin and anterior placenta. INTERVENTIONS: Both of the 2 cases were underwent a new method for MFPR involving fine needle amniotic fluid aspiration and injection of hypertonic sodium chloride (10% NaCl) into the Wharton jelly of the umbilical cord. OUTCOMES: The 2 cases resulted in selective feticide and the birth of the remaining infants from the triplet pregnancies. All infants were healthy at birth and the 2-year follow-up. LESSONS: The new approach provided a safer, more accessible, and more cost-effective method for MFPR in MMPs with a contraindication to fetoscopic surgery compared to radiofrequency ablation and fetoscopic laser surgery.
[Mh] Termos MeSH primário: Redução de Gravidez Multifetal/métodos
[Mh] Termos MeSH secundário: Adulto
Contraindicações
Feminino
Transfusão Feto-Fetal
Fetoscopia
Seres Humanos
Gravidez
Gravidez Múltipla
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170309
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006250


  7 / 1554 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28267443
[Au] Autor:Jiménez JA; Eixarch E; DeKoninck P; Bennini JR; Devlieger R; Peralta CF; Gratacos E; Deprest J
[Ad] Endereço:Department of Development and Regeneration, Group Biomedical Sciences, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, Clínica Alemana, Universidad del Desarrollo Santiago, Chile.
[Ti] Título:Balloon removal after fetoscopic endoluminal tracheal occlusion for congenital diaphragmatic hernia.
[So] Source:Am J Obstet Gynecol;217(1):78.e1-78.e11, 2017 Jul.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Isolated congenital diaphragmatic hernia defect allows viscera to herniate into the chest, competing for space with the developing lungs. At birth, pulmonary hypoplasia leads to respiratory insufficiency and persistent pulmonary hypertension that is lethal in up to 30% of patients. Antenatal measurement of lung size and liver herniation can predict survival after birth. Prenatal intervention aims at stimulating lung development, clinically achieved by percutaneous fetal endoscopic tracheal occlusion under local anesthesia. This in utero treatment requires a second intervention to reestablish the airway, either before birth or at delivery. OBJECTIVE: To describe our experience with in utero endotracheal balloon removal. MATERIALS AND METHODS: This is a retrospective analysis of prospectively collected data on consecutive patients with congenital diaphragmatic hernia treated in utero by fetal endoscopic tracheal occlusion from 3 centers. Maternal and pregnancy-associated variables were retrieved. Balloon removal attempts were categorized as elective or emergency and by technique (in utero: ultrasound-guided puncture; fetoscopy; ex utero: on placental circulation or postnatal tracheoscopy). RESULTS: We performed 351 balloon insertions during a 144-month period. In 9 cases removal was attempted outside fetal endoscopic tracheal occlusion centers, 3 of which were deemed impossible and led to neonatal death. We attempted 302 in-house balloon removals in 292 fetuses (217 elective [71.8%], 85 emergency [28.2%]) at 33.4 ± 0.1 weeks (range: 28.9-37.1), with a mean interval to delivery of 16.6 ± 0.8 days (0-85). Primary attempt was by fetoscopy in 196 (67.1%), by ultrasound-guided puncture in 62 (21.2%), by tracheoscopy on placental circulation in 30 (10.3%), and postnatal tracheoscopy in 4 cases (1.4%); a second attempt was required in 10 (3.4%) cases. Each center had different preferences for primary technique selection. In elective removals, we found no differences in the interval to delivery between fetoscopic and ultrasound-guided puncture removals. Difficulties during fetoscopic removal led to the development of a stylet to puncture the balloon, leading to shorter operating time and easier reestablishment of airways. CONCLUSION: In these fetal treatment centers, the balloon could always be removed successfully. In 90% this was in utero, with the use of fetoscopy preferred over ultrasound-guided puncture. Ex utero removal was a fall-back procedure. In utero removal does not seem to precipitate immediate membrane rupture, labor, or delivery, although the design of the study did not allow for a formal conclusion. For fetoscopic removals, the introduction of a stylet facilitated retrieval. Successful removal may rely on a permanently prepared team with expertise in all possible techniques.
[Mh] Termos MeSH primário: Oclusão com Balão
Doenças Fetais/terapia
Fetoscopia/métodos
Hérnias Diafragmáticas Congênitas/terapia
Traqueia
[Mh] Termos MeSH secundário: Parto Obstétrico
Endoscopia/métodos
Feminino
Idade Gestacional
Seres Humanos
Pneumopatias/embriologia
Pneumopatias/etiologia
Pneumopatias/prevenção & controle
Gravidez
Punções
Estudos Retrospectivos
Ultrassonografia Pré-Natal
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170308
[St] Status:MEDLINE


  8 / 1554 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28244950
[Au] Autor:Arens C; Koch C; Veit M; Greenberg RS; Lichtenstern C; Weigand MA; Khaleeva A; Schuerg R; Kohl T
[Ad] Endereço:From the *Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany; †Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Giessen, Germany; ‡Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland; and §German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT), University of Giessen and Marburg, Giessen, Germany.
[Ti] Título:Anesthetic Management for Percutaneous Minimally Invasive Fetoscopic Surgery of Spina Bifida Aperta: A Retrospective, Descriptive Report of Clinical Experience.
[So] Source:Anesth Analg;125(1):219-222, 2017 Jul.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Minimally invasive fetoscopic surgery for spina bifida aperta is a new therapeutic approach to preserve neurologic function by protecting exposed neural tissue. The anesthetic management is of paramount importance for the success of the procedure. Therefore, our protocol was developed with particular attention to safe and adequate maternal and fetal anesthesia, sufficient uterine relaxation as well as prevention of pulmonary edema, placental abruption, and spontaneous labor. As illustrated by this retrospective analysis of 61 cases, these goals can be reliably achieved. The clinical protocol is presented as a supplemental digital content to this manuscript (Supplemental Digital Content 1, http://links.lww.com/AA/B733).
[Mh] Termos MeSH primário: Anestesia/métodos
Fetoscopia
Espinha Bífida Cística/cirurgia
[Mh] Termos MeSH secundário: Adulto
Anestésicos
Feminino
Feto
Idade Gestacional
Hemodinâmica
Seres Humanos
Complicações Pós-Operatórias
Gravidez
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170808
[Lr] Data última revisão:
170808
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170301
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000001896


  9 / 1554 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28205301
[Au] Autor:Van Mieghem T; Bianchi DW; Levy B; Deprest J; Chitty LS; Ghidini A
[Ad] Endereço:Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
[Ti] Título:In case you missed it: the Prenatal Diagnosis editors bring you the most significant advances of 2016.
[So] Source:Prenat Diagn;37(2):117-122, 2017 Feb.
[Is] ISSN:1097-0223
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Diagnóstico Pré-Natal
Editoração/tendências
[Mh] Termos MeSH secundário: Políticas Editoriais
Pesquisas com Embriões
Feminino
Fetoscopia/métodos
Fetoscopia/tendências
Edição de Genes/tendências
Seres Humanos
Terapia de Substituição Mitocondrial/tendências
Mosaicismo
Gravidez
Diagnóstico Pré-Natal/métodos
Diagnóstico Pré-Natal/normas
Diagnóstico Pré-Natal/tendências
Editoração/normas
Tropismo Viral/fisiologia
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170217
[St] Status:MEDLINE
[do] DOI:10.1002/pd.5007


  10 / 1554 MEDLINE  
              first record previous record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28005161
[Au] Autor:Kiefer N; Suter SF; Berg C; Gembruch U; Weber SU
[Ad] Endereço:Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund Freud Straße 25, 53105, Bonn, Deutschland. nicholas.kiefer@ukb.uni-bonn.de.
[Ti] Título:[Epidural anesthesia for fetoscopy : Retrospective analysis of a one-year cohort].
[Ti] Título:Peridurale Anästhesie zur Fetoskopie : Retrospektive Analyse einer Einjahreskohorte..
[So] Source:Anaesthesist;66(1):28-33, 2017 Jan.
[Is] ISSN:1432-055X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:BACKGROUND: The introduction of routine prenatal screening using ultrasound has led to a substantial increase in diagnoses of fetal disorders that are amenable to intrauterine treatment. While an ultrasound guided insertion of small bore cannulas can be performed under local anesthesia, insertion of a fetoscope usually requires anesthetic management for the mother and the fetus. Additionally, the fetus' intrauterine position may have to be manipulated in order to enable access. Such manoeuvres depend on relaxation of the mother's abdominal wall. General anesthesia has been the preferred method, but it involves substantial risks both to the mother and possibly the fetus, especially when combined with aggressive uterine relaxation. Epidural anesthesia (EA) may provide an alternative. Only little systematic data on the efficacy, requirements or untoward effects of epidural anesthesia for fetoscopy exists in the literature, yet a high rate of arterial hypotension following EA has been reported. We therefore aimed to assess the hemodynamic reaction to EA in a mixed population of pregnant women undergoing fetoscopy for a variety of fetal conditions and performed a retrospective analysis of a one-year cohort in a single university hospital. METHODS: The local ethics committee approved this retrospective analysis and waived patient consent (local study identifier 304/14). We extracted anesthesiologic and hemodynamic data from the anesthesia charts of 23 consecutive cases of elective fetoscopic procedures requiring anesthesia between May 2011 and 2012 at a German university medical centre. RESULTS: Twenty-three cases of fetoscopy were included in this study. Indications for fetoscopy were congenital diaphragmatic hernia (n = 9), aortic valve stenosis (n = 8), and feto-fetal transfusion syndrome (n = 6). Median gestational age was 26 (8, interquartile range) weeks. Lumbar epidural catheters were injected with a median dose of 0.09 (0.02, interquartile range) ml ropivacaine 0.75% per cm maternal height. In 11 patients, EA was titrated to a sufficient height whereas 12 patients received a single dose with a median volume of 0.08 (0.02) ml/cm maternal height. After injection, systolic arterial pressure did not change significantly, mean arterial pressure dropped from 93 (14) mm Hg to 88 (15) mm Hg (p = 0.03). Heart rate fell from 96 (29) to 89 (20) beats per minute (p = 0.02). At incision, neither blood pressure nor heart rate changed significantly. For hemodynamic support during the procedure, cafedrine/theodrenaline (Akrinor™) was injected in five patients (median dose in these patients 0.5 (1.5) ml). One patient carrying a fetus with a poor prognosis and who underwent two separate procedures demanded additional sedation, for which we chose remifentanil. Another patient was hypotensive after intravenous administration of the tocolytic drug atosiban. A stable hemodynamic condition was quickly restored in this patient with administration of cafedrine/theodrenaline and i. v. fluids. All procedures were performed without conversion to general anaesthesia. CONCLUSION: This retrospective study demonstrates that fetoscopic procedures under EA in the range of indications treated in our institution can be performed safely. EA was associated with stable hemodynamic conditions in this mixed cohort of pregnant women. EA appears thus to be a suitable technique for fetoscopy, avoiding the risks inherent to general anesthesia in pregnant women.
[Mh] Termos MeSH primário: Anestesia Epidural/métodos
Fetoscopia/métodos
[Mh] Termos MeSH secundário: Adulto
Amidas
Anestésicos Locais
Pressão Arterial/efeitos dos fármacos
Estudos de Coortes
Sedação Consciente
Feminino
Idade Gestacional
Frequência Cardíaca/efeitos dos fármacos
Hemodinâmica
Seres Humanos
Região Lombossacral
Gravidez
Estudos Retrospectivos
Vasodilatadores/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Amides); 0 (Anesthetics, Local); 0 (Vasodilator Agents); 7IO5LYA57N (ropivacaine)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170916
[Lr] Data última revisão:
170916
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161223
[St] Status:MEDLINE
[do] DOI:10.1007/s00101-016-0253-5



página 1 de 156 ir para página                         
   


Refinar a pesquisa
  Base de dados : MEDLINE Formulário avançado   

    Pesquisar no campo  
1  
2
3
 
           



Search engine: iAH v2.6 powered by WWWISIS

BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde