THE INFLUENCE OF INTRAVEOUNS ANESTHETICS ON FETUS

Posljednja dva desetljeća postoji sve više istraživanja koja spominju štetni utjecaj intravenskih anestetika na fetus i malo dijete u razvoju, a najviše zabrinjava njihov utjecaj na razvoj mozga. Tako je američka agencija za hranu i lijekove (FDA) izdala upozorenje o općim anesteticima zbog reporoducibilnih dokaza u pretkliničkim studijama, a upozorili su na korištenje intravenskih anestetika u intervencijama na trudnicama i fetalnim operacijama. Ovaj rad pregledom pretkliničkih i kliničkih istraživanja na temu štetnosti intravenskih anestetika tijekom ne-opstetričkih operacija, izvođenja carskog reza te fetalnih zahvata i operacija pokušava razlučiti o njihovoj štetnosti i poželjnim učincima. Pojam koji se u in vitro i in vivo studijama pojavljuje često je neuroapoptotičko djelovanje intravenskih anestetika na mozak, a najistraživaniji je utjecaj propofola i ketamina preko gama-aminomaslačnih (GABA) i N-metil D-aspartat (NMDA) receptora. Osim štetnog utjecaja rad se dotiče i korisnih karakteristika, pa čak i poželjnog učinka na fetus i majku, koji određeni intravenski anestetici, poput dexmedetomidina i ketamina, mogu imati kada se kombiniraju sa drugim intravenskim ili inhalatornim anesteticima. Na kraju, u radu se uspoređuju rezultati kliničkih i pretkliničkih istraživanja s obzirom da klinička istraživanja nisu mogla ponoviti iste teze o štetnosti intravenskih anestetika koje su utvrđene pretkliničkim istraživanjima. Konačni zaključci o štetnosti intravenskih anestetika nisu doneseni jer je potrebno više kliničkih studija koje bi potvrdile štetnost, a u sadašnjoj primjeni njihova korist nadvladava moguću štetnost. Oprez se savjetuje pri titriranju doza kod duže izloženosti intravenskim anesteticima.Over the span of the last two decades there have been reports of adverse effects of intravenous anesthetics on the fetus and children in developing stages but most concering is the effect on the brain development. The FDA has issued a warning concerning this fact about general anesthetics because of the multitude of preclinical evidence about adverse effects and warned the medical community about use of intravenous anesthetics in interventions regarding a pregnant woman and fetus. This paper reviewing the preclinical and clinical research on adverse effects of intravenous anesthetics during non-obstetric operations, cesarean section and fetal interventions is trying to distinguish the desirable effects and advers effects that anesthetics can harbour. In vitro and in vivo studies have shown that anesthetics such as propofol and ketamine have neuroapoptotical effect on brain in fetuses. This mechanism they've attributed to the receptors of intravenous anesthetics that are predominantly GABA and NMDA receptors. Besides the widely reported adverse effects, this paper reviews some of the desirable effects that have been reported with use of dexmedetomidine and ketamine when combined with other intravenous anesthetics or inhalation anesthetics. In the end, paper compares the resultes of preclinical and clinical studies based on the fact that in the clinical studies the same results of adverse effects could not have been replicated. Final conclusion concerned with whether intravenous anesthetics have harmful effects have not been made. It is noted that caution is need when titrating the dose during longer exposition to intravenous anesthetics