Tom Bleeser1,2,3, Lennart Van Der Veeken3,4,5, Sarah Devroe1,2,3, Simen Vergote3,4,5, Doaa Emam3,4,5,6, Johannes van der Merwe3,4,5, Elina Ghijsens4, Luc Joyeux3,4,5,7, David Basurto3,4,5, Marc Van de Velde1,2, Jan Deprest3,4,5,8, Steffen Rex9,10. 1. Department of Anesthesiology, UZ Leuven, Leuven, Belgium. 2. Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium. 3. Department of Development and Regeneration, My FetUZ Fetal Research Center, KU Leuven, Leuven, Belgium. 4. Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium. 5. Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium. 6. Department Obstetrics and Gynecology, University Hospitals Tanta, Tanta, Egypt. 7. Department of Pediatric Surgery, Great Ormond Street Hospital, University College London Hospitals, London, United Kingdom. 8. Institute for Women's Health, University College London, London, United Kingdom. 9. Department of Anesthesiology, UZ Leuven, Leuven, Belgium, steffen.rex@uzleuven.be. 10. Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium, steffen.rex@uzleuven.be.
Abstract
INTRODUCTION: Anesthesia during pregnancy can impair fetal neurodevelopment, but effects of surgery remain unknown. The aim is to investigate effects of abdominal surgery on fetal brain development. Hypothesis is that surgery impairs outcome. METHODS: Pregnant rabbits were randomized at 28 days of gestation to 2 h of general anesthesia (sevoflurane group, n = 6) or to anesthesia plus laparoscopic appendectomy (surgery group, n = 13). On postnatal day 1, neurobehavior of pups was assessed and brains harvested. Primary outcome was neuron density in the frontal cortex, and secondary outcomes included neurobehavioral assessment and other histological parameters. RESULTS: Fetal survival was lower in the surgery group: 54 versus 100% litters alive at birth (p = 0.0442). In alive litters, pup survival until harvesting was 50 versus 69% (p = 0.0352). No differences were observed for primary outcome (p = 0.5114) for surviving pups. Neuron densities were significantly lower in the surgery group in the caudate nucleus (p = 0.0180), but not different in other regions. No differences were observed for secondary outcomes. Conclusions did not change after adjustment for mortality. CONCLUSION: Abdominal surgery in pregnant rabbits at a gestational age corresponding to the end of human second trimester results in limited neurohistological changes but not in neurobehavioral impairments. High intrauterine mortality limits translation to clinical scenario, where fetal mortality is close to zero.
INTRODUCTION: Anesthesia during pregnancy can impair fetal neurodevelopment, but effects of surgery remain unknown. The aim is to investigate effects of abdominal surgery on fetal brain development. Hypothesis is that surgery impairs outcome. METHODS: Pregnant rabbits were randomized at 28 days of gestation to 2 h of general anesthesia (sevoflurane group, n = 6) or to anesthesia plus laparoscopic appendectomy (surgery group, n = 13). On postnatal day 1, neurobehavior of pups was assessed and brains harvested. Primary outcome was neuron density in the frontal cortex, and secondary outcomes included neurobehavioral assessment and other histological parameters. RESULTS: Fetal survival was lower in the surgery group: 54 versus 100% litters alive at birth (p = 0.0442). In alive litters, pup survival until harvesting was 50 versus 69% (p = 0.0352). No differences were observed for primary outcome (p = 0.5114) for surviving pups. Neuron densities were significantly lower in the surgery group in the caudate nucleus (p = 0.0180), but not different in other regions. No differences were observed for secondary outcomes. Conclusions did not change after adjustment for mortality. CONCLUSION: Abdominal surgery in pregnant rabbits at a gestational age corresponding to the end of human second trimester results in limited neurohistological changes but not in neurobehavioral impairments. High intrauterine mortality limits translation to clinical scenario, where fetal mortality is close to zero.
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