Anaesthesia for non-obstetric surgery during pregnancy

Abstract

Non-obstetric surgery during pregnancy posts additional concerns to anaesthesiologists. The chief goals are to preserve maternal safety, maintain the pregnant state and achieve the best possible foetal outcome. The choice of anaesthetic technique and the selection of appropriate anaesthetic drugs should be guided by indication for surgery, nature, and site of the surgical procedure. Anaesthesiologist must consider the effects of the disease process itself and inhibit uterine contractions and avoid preterm labour and delivery. Foetal safety requires avoidance of potentially dangerous drugs and assurance of continuation of adequate uteroplacental perfusion. Until date, no anaesthetic drug has been shown to be clearly dangerous to the human foetus. The decision on proceeding with surgery should be made by multidisciplinary team involving anaesthesiologists, obstetricians, surgeons and perinatologists. This review describes the general anaesthetic principles, concerns regarding anaesthetic drugs and outlines some specific conditions of non-obstetric surgeries.

Non-obstetric surgery during pregnancy – an eleven-year retrospective analysis

“…None of the premature labors or miscarriages in our study was directly connected to surgical intervention. There is general agreement that surgical intervention should be performed in pregnant women whenever indicated; to our knowledge, there is no published report recommending general avoidance of surgical intervention during pregnancy, except for some recommendations concerning interventions in the third trimester [11,14]. Further research on non-obstetric surgical interventions in pregnant women is warranted to develop guidelines for optimal pre-and postoperative management in pregnant women.…”

“…The most frequent indications for surgery during pregnancy are infections such as acute appendicitis and cholecystitis [5][6][7][8][9][10][11][12][13][14]; pregnant women may also require acute surgical intervention for ovarian disorders and bowel obstruction, as well as for traumatological or oncological indications [11]. Any kind of pathology can occur in pregnant women and require immediate surgical treatment and optimized interdisciplinary management to achieve maximum safety for both mother and fetus, to avoid teratogenous medication, fetal acidosis and hypoxemia, and adverse pregnancy outcomes such as miscarriage, stillbirth or premature birth [4,8].…”

Pregnant Women Positioning in Spinal Anesthesia for Cesarean Section: Integrative Review

“…Positioning to perform the anesthetic procedure should be chosen by analyzing possible complications and physiological changes of the age group undergoing anesthesia [14]. In pregnant women, the primary criterion in the choice of positioning for spinal anesthesia is maternal hemodynamic stability because reduction of pregnant women's blood pressure impairs placental perfusion and is as a risk for the mother and the baby [15].…”

“…This fact predisposes pregnant women to present hypotension according to their position [15]. In addition to pregnant women's body changes that lead to the risk of hypotension, reduction in blood pressure is also one of the complications of spinal anesthesia [16], which leads pregnant women exposed to this anesthetic modality to have the sum of two factors that induce the decrease in pressure values.…”

Erector spinae plane block as rescue analgesia in gestational week 16

“…Regional blockade techniques are preferred, as they reduce the risk of opioidinduced hypoventilation. [3] Among regional block techniques, ultrasound (US)-guided erector spinae plane block (ESPB) is a novel interfacial plan block, which was first described by Forero et al in 2016 as a treatment for thoracic neuropathic pain. [4] There are a number of case reports in the literature on the analgesic effect of ESPB after laparoscopic surgeries.…”