Anesthesia Management in Pregnancy
Özet
This comprehensive chapter outlines anesthesia management for pregnant patients undergoing non-obstetric surgery, emphasizing that 0.75% to 2.0% of pregnancies require such interventions, primarily during the first trimester. The author highlights the profound physiological adaptations occurring in maternal systems—including respiratory, cardiovascular, gastrointestinal, and central nervous systems—which significantly elevate anesthesia risks and necessitate precise adjustments. Key maternal management strategies include meticulous airway assessment, rapid sequence induction, left lateral tilt positioning to prevent supine hypotension, and mandatory acid aspiration prophylaxis from the 16th gestational week. Fetal considerations emphasize continuous heart rate monitoring starting from the 18th week, since anesthetic agents can alter baseline readings and variability. The text evaluates pharmacological profiles, referencing the US FDA risk classification and noting that neuromuscular blockers exhibit limited placental transfer. While nitrous oxide and benzodiazepines are linked to specific risks like cleft palate, a single dose of benzodiazepines appears safe, and overall surgical pathology poses a higher abortion risk than anesthesia itself. Ultimately, elective surgeries should be deferred to the second trimester, and successful outcomes depend on comprehensive preoperative evaluation, effective postoperative analgesia to prevent premature labor, thromboprophylaxis, and disciplined multidisciplinary collaboration.
Referanslar
Haggerty E, Daly J. Anaesthesia and non-obstetric surgery in pregnancy. BJA Educ. 2021;21(2):42-43.
Aptilon Duque G, Mohney S. Appendicitis in Pregnancy. [Updated 2021 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551642/
Deledda A, Pintus S, Loviselli A, Fosci M, Fantola G, Velluzzi F. Nutritional Management in Bariatric Surgery Patients. Int J Environ Res Public Health. 2021;18(22):12049.
Nessah K, Dargent D, Mellier G. Laparoscopic management of adnexal masses in pregnancy: a case series. Eur J Obstet Gynecol Reprod Biol 2003;108:217 – 22.
Ní Mhuireachtaigh R, O'Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth. 2006;18(1):60-66.
Melnick DM, Wahl WL, Dalton VK. Management of general surgical problems in the pregnant patient. Am J Surg. 2004;187(2):170-180.
Mahli A, Izdes S, Coskun D. Cardiac operations during pregnancy: review of factors influencing fetal outcome. Ann Thorac Surg. 2000;69(5):1622-1626.
Biro P. Difficult intubation in pregnancy. Curr Opin Anaesthesiol 2011;24:249–254.
Boutonnet M, Faitot V, Keïta H: Airway management in obstetrics. Ann Fr Anesth Reanim 2011;30:651–664.
Hignett R, Fernando R, McGlennan A, et al. A randomized crossover study to determine the effect of a 30° head-up versus a supine position on the functional residual capacity of term parturients. Anesth Analg 2011;113: 1098–1102.
Van de Velde M, De Buck F. Fetal and maternal analgesia/anesthesia for fetal procedures. Fetal Diagn Ther. 2012;31(4):201-209.
Carlin A, Alfirevic Z: Physiological changes of pregnancy and monitoring. Best Pract Res Clin Obstet Gynaecol 2008;22:801–823.
Hui C, Lili M, Libin C, et al. Changes in coagulation and hemodynamics during pregnancy: a prospective longitudinal study of 58 cases. Arch Gynecol Obstet. 2012;285(5):1231-1236.
Paranjothy S, Griffiths JD, Broughton HK, Gyte GML, Brown HC, Thomas J: Interventions at caesarean section for reducing the risk of aspiration pneumonitis. Int J Obstet Anesth 2011;20:142–148.
Paul M, Iung B, Montravers P, Longrois D, Guglielminotti J. Prise en charge anesthésique de l'accouchement des patientes porteuses d'une bicuspidie aortique. À propos de deux cas consécutifs [Anaesthetic management of patients with bicuspid aortic valve for delivery. About two consecutive cases]. Ann Fr Anesth Reanim. 2013;32(9):607-610.
Zhan Q, Huang S, Geng G, Xie Y: Comparison of relative potency of intrathecal bupivacaine for motor block in pregnant versus non-pregnant women. Int J Obstet Anesth 2011;20:219–223.
Bajwa SJ, Bajwa SK, Kaur J, SinghA. Rare artifacts mimicking sinus tachycardia in a case of vaginal hysterectomy with situs inversus totalis. Anesth Essays Res 2011;5:244 5.
Hyland SJ, Brockhaus KK, Vincent WR, et al. Perioperative Pain Management and Opioid Stewardship: A Practical Guide. Healthcare (Basel). 2021;9(3):333.
Upadya M, Saneesh PJ. Anaesthesia for non-obstetric surgery during pregnancy. Indian J Anaesth 2016;60:234-41.
Li X, Wu C, Zhou X, et al. Influence of painless delivery on the maternal and neonatal outcomes under the guidance of new concept of labor. Am J Transl Res. 2021;13(11):12973-12979.
Lee JM, Shin TJ. Use of local anesthetics for dental treatment during pregnancy; safety for parturient. J Dent Anesth Pain Med. 2017;17(2):81-90.
Scaparrotta A, Chiarelli F, Verrotti A. Potential Teratogenic Effects of Clomiphene Citrate. Drug Saf. 2017;40(9):761-769.
Haggerty E, Daly J. Anaesthesia and non-obstetric surgery in pregnancy. BJA Educ. 2021;21(2):42-43.
Ko H, Kaye AD, Urman RD. Nitrous oxide and perioperative outcomes. J Anesth. 2014;28(3):420-428.
James C, Millar J, Horton S, Brizard C, Molesworth C, Butt W. Nitric oxide administration during paediatric cardiopulmonary bypass: a randomised controlled trial. Intensive Care Med. 2016;42(11):1744-1752.
Sheehy O, Zhao J, Bérard A. Association Between Incident Exposure to Benzodiazepines in Early Pregnancy and Risk of Spontaneous Abortion. JAMA Psychiatry. 2019;76(9):948–957.
Safra MJ, Oakley GP. Association between cleft lip with or without cleft palate and prenatal exposure to diazepam. Lancet 1975;2: 478 - 80.
Maronge L, Bogod D. Complications in obstetric anaesthesia. Anaesthesia. 2018;73 Suppl 1:61-66.
Chatterjee D, Arendt KW, Moldenhauer JS, et al. Anesthesia for Maternal-Fetal Interventions: A Consensus Statement From the American Society of Anesthesiologists Committees on Obstetric and Pediatric Anesthesiology and the North American Fetal Therapy Network. Anesth Analg. 2021;132(4):1164-1173.
Schaeffer MR, Guenette JA, Jensen D. Impact of ageing and pregnancy on the minute ventilation/carbon dioxide production response to exercise. Eur Respir Rev. 2021;30(161):200225.
Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27(2):89-94.
Fernandes NL, Dyer RA. Anesthesia for Urgent Cesarean Section. Clin Perinatol. 2019;46(4):785-799.
Sen C. Preterm labor and preterm birth. J Perinat Med. 2017;45(8):911-913.
Landau R, Kraft JC. Pharmacogenetics in obstetric anesthesia. Curr Opin Anaesthesiol. 2010;23(3):323-329.
