From premature anesthesia-induced labor to material hypoxia, anesthesia can pose significant risks to pregnant patients [1]. Because no anesthetic agent avoids all risks, the best choice is to avoid surgery during pregnancy altogether when possible [1]. When surgery cannot be avoided, anesthesiologists must carefully consider factors such as the preoperative evaluation, technique, and fetal monitoring to avoid endangering the health of the patient and the fetus [1].

To craft the best anesthesia plan possible, preparation is key [2]. A preoperative evaluation should occur, and it should include standard medical tests and special counseling about the anesthetic risks of the surgery [2, 3]. During testing, special attention should be granted to the airway examination [2]. Unless special circumstances arise, surgery should be scheduled for the second trimester to avoid complications and preterm birth [4]. Depending on the results of preoperative tests, alongside other pertinent considerations, pre-treatment may be recommended [2]. Patients could benefit from consuming folic or folinic acid after the first trimester [1]. Additionally, sodium citrate and H2 blockers can also help decrease the risk of aspiration, especially if general anesthesia is planned [2, 3].

Teratogenesis is a prominent concern for anesthetists treating pregnant surgical patients [5]. Unfortunately, researchers have found that nearly every anesthetic drug on the market can have teratogenic effects on some animal species during gestation [5]. As a result, anesthetists tend to choose the anesthetic agent by referring to standard considerations, such as patient comorbidities and type of surgery [5].

Along with teratogenesis, general anesthesia can cause lower birth weight and neonatal depression [4, 5]. Therefore, anesthesia providers should choose regional anesthesia whenever possible [1, 6]. When picking between regional anesthesia techniques, medical teams must consider how some forms of regional anesthesia, such as brachial plexus and epidural block, typically yield high local anesthetic blood levels [1]. As a result, spinal anesthesia is preferable because it “offers the least drug transfer for the degree of anesthesia achieved” [1].

It is important to note that general anesthesia may be necessary in some cases [5]. Fortunately, it can be perfectly safe when performed by a skilled professional [5]. To minimize the risk of airway-related complications, physicians should only elect to have their patient wear a mask or laryngeal mask airway if they are certain that such devices can be used safely [6].

During surgery, the anesthesiologist should use standard anesthesia-induction and monitoring techniques [3]. Depending on the patient, fetal monitoring can also be helpful [6]. Medical practitioners should remember that loss of fetal heart rate variability is not necessarily a sign of fetal distress and that a slowed fetal heart rate can be caused by several factors, such as maternal respiratory acidosis or a decrease in temperature [6]. Regardless, medical teams should carefully monitor the effects of the anesthetic agents on the patient and fetus to avoid severe complications [6].

In conclusion, it is crucial to conduct preoperative evaluations, choose regional anesthesia whenever possible, and closely monitor the fetus and patient during surgery. When medical professionals carefully follow these steps, non-obstetric surgeries during pregnancy can be highly successful.

References 

[1] K. Kuczkowski, “Nonobstetric Surgery During Pregnancy: What Are the Risks of Anesthesia?,” Obstetrical & Gynecological Survey, vol. 59, no. 1, p. 52-56, January 2004. [Online]. Available: https://doi.org/10.1097/01.OGX.0000103191.73078.5F. 

[2] S. J. S. Bajwa and S. K. Bajwa, “Anaesthetic challenges and management during pregnancy: Strategies revisited,” Anesthesia Essays and Researches, vol. 7, no. 2, p. 160-167, May-August 2013. [Online]. Available: https://doi.org/10.4103/0259-1162.118945. 

[3] T. G. Cheek and E. Baird, “Anesthesia for Nonobstetric Surgery: Maternal and Fetal Considerations,” Clinical Obstetrics and Gynecology, vol. 52, no. 4, p. 535-545, December 2009. [Online]. Available: https://doi.org/10.1097/GRF.0b013e3181c11f60. 

[4] S. Devroe et al., “Anesthesia for non-obstetric surgery during pregnancy in a tertiary referral center: a 16-year retrospective, matched case-control, cohort study,” International Journal of Obstetric Anesthesia, vol. 39, p. 74-81, August 2019. [Online]. Available: https://doi.org/10.1016/j.ijoa.2019.01.006. 

[5] M. C. Tolcher, W. E. Fisher, and S. L. Clark, “Nonobstetric Surgery During Pregnancy,” Obstetrics & Gynecology, vol. 132, no. 2, p. 395-403, August 2018. [Online]. Available: https://doi.org/10.1097/AOG.0000000000002748. 

[6] E. Reitman and P. Flood, “Anaesthetic considerations for non-obstetric surgery during pregnancy,” British Journal of Anaesthesia, vol. 107, no. 1, p. i72-i78, December 2011. [Online]. Available: https://doi.org/10.1093/bja/aer343.