Anesthesia for Non-Obstetrical Surgery during Pregnancy

Abstract

The number of surgical procedures in gravid women unrelated to pregnancy itself has been increased over years. In such cases, one must keep in mind the responsibility for two patients, the optimization and maintenance of maternal homeostasis, avoiding alterations on uteroplacental perfusion that can bring harm to the fetus. This review focus on safety to performing these procedures during pregnancy, considering the advances in the prevention and treatment of obstetric and fetal morbidity related to anesthesia. Background and Objectives:Despite research advances, there is still much controversy in the anesthetic management of obstetric patients. Several studies have demonstrated the safety of anesthesia in this group of patients. In this review an analysis of anesthetics used in clinical practice is proposed as well as the technique to be chosen and its effects on the mother and fetus in non-obstetric surgery during pregnancy.

Perioperative management of surgical procedure during pregnancy: a systematic review

“…These changes are crucial to ensure an adequate supply of oxygen and nutrients to the foetus and to prepare the mother’s body for childbirth 13 . Secondary changes occur due to the mechanical effects of the enlarged pregnant uterus 3 . Understanding the adaptations of the central nervous system (CNS), respiratory, gastrointestinal, cardiovascular, and haematologic systems during pregnancy can help in selecting the most appropriate anaesthetic technique and optimize maternal hemodynamics intraoperatively 14 (Table 1 ).…”

“…The risks of surgery during pregnancy are influenced by several factors, including physiological changes, potential adverse effects of anaesthetic medications, gestational age, the type, duration, and location of the surgery, anaesthetic technique, and the general condition of the patient 18 . Both general and regional anaesthesia can be used 3 .…”

“…Approximately 1–2% of pregnant women undergo non-obstetric surgery under anaesthesia during their pregnancy 1 – 3 . The occurrence of surgical procedures in pregnant women unrelated to gestation itself has become relatively common and has increased over the years.…”

“…The most common indications for surgery during pregnancy include both pregnancy-related issues, such as cervical incompetence and surgical management of ovarian cyst problems, as well as non-pregnancy-related acute abdominal problems, maternal trauma, and maternal malignancies 10 . Appendicitis, cholecystitis, ovarian torsion, maternal malignancies, and trauma are indeed among the more common indications for surgical interventions during pregnancy 1 , 3 .…”

<b>Damage caused by exposure to propofol during gestation of mice

“…Approximately 42% non-obstetrical surgeries are performed during the first trimester of pregnancy, 35% in the second and 23% in the third (Reitman & Flood, 2011;Mandim, Ruzi, Bernardes, & Teixeira, 2015). However, the number established for the first quarter may in fact be higher than in reality, since it is possible that early pregnancy may not be confirmed during this period.…”