@DevroeSarah presents on Anaesthesia in Pregnancy and Neurodevelopment at #OAA23ASM. Quite an outline! #OBAnes
@DevroeSarah begins with epidemiology - 0.4-1% pregnant women will have non-OB surgery during their pregnancy. Fetus = innocent bystander. Complicated question. What is the pathobiology of normal brain development? Is there a link between anaesthesia and impaired brain… twitter.com/i/web/status/1…
Mechanisms? Drug-induced vs multifactorial. Preclinical evidence of consistent association. Clinical evidence inconclusive. Preclinical findings certainly headline grabbing, which prompted a systematic review and meta-analysis from Bleeser et al (incl. @DevroeSarah @rex_steffen… twitter.com/i/web/status/1…
Why the sense of urgency? 2016 FDA safety announcement: repeated or lengthy GA/ sedation under 3years or in pregnant women during third trimester MAY affect the developing brain (making GA section more scary - albeit questionable evidence). Sadly, most models lacked clinical… twitter.com/i/web/status/1…
Enter the Bleeser et al propensity-score weighted bidirectional cohort study. BRIEF global executive composite. Ranked comparison of effect size - anaesthesia highlighted. #OBAnes #OAA23ASM
Neurodevelopmental effects of prenatal exposure to anaesthesia comparable to “innocent” risk factors. Case closed? Maybe. Some subgroups demonstrated differences - worthy of further focussed study? #OBAnes #OAA23ASM
Future perspectives: can we do better? Alternative anaesthetics & physiologic neuro protection have been suggested. Targets for alternative anaesthetics include inflammation, neurotoxicity and immature vascularisation. Dexmedetomidine may be neuroprotective, over & above reducing… twitter.com/i/web/status/1…
Physiologic neuroprotection: maternal hemodynamic management; maternal ventilation/ oxygenation management; and depth of anaesthesia management have all been proposed to play a role. #OBAnes #OAA23ASM
Practical approach and recommendations from @DevroeSarah. And it’s not only #OBAnes opinion, @acog committee opinion as well. Consider alternative anaesthetics, provide physiologic neuroprotection. #OAA23ASM
@threadreaderapp unroll please
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