Anesthetic Management of Nonobstetric Surgery during Pregnancy
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Purpose of Review
This article reviews several controversial aspects of management of nonobstetric surgery during pregnancy, including the optimal timing for nonurgent surgery, when to perform intraoperative fetal monitoring, modifications to anesthetic techniques to account for the physiologic changes of pregnancy, and management of maternal cardiac arrest.
There have been several advances in the management of nonobstetric surgery during pregnancy, including the increased use of laparoscopic techniques, an improved understanding of the importance of adequate pain management, and new initiatives to improve the maternal cardiac resuscitation algorithm. Traditional dogma regarding aspiration prophylaxis during pregnancy and concerns about abortifacient and teratogenic properties of diagnostic imaging and anesthetic agents have also recently been reevaluated.
Urgent and emergent surgeries should proceed without delay during pregnancy in order to ensure optimal outcomes for both the mother and fetus. Anesthetic management may require several modifications to account for physiologic changes of pregnancy. In general, uteroplacental perfusion is best maintained by avoidance of maternal hypoxemia, hypotension, hyper- and hypocapnia, temperature extremes, and stress.
KeywordsPregnancy Physiologic changes of pregnancy Nonobstetric surgery during pregnancy Teratogenicity Preterm labor Intraoperative fetal monitoring Left uterine displacement General anesthetics in pregnancy Deep sedation during pregnancy Regional anesthesia Neuraxial anesthesia Laparoscopic surgery Maternal cardiac arrest Perimortem delivery
Compliance with Ethical Standards
Conflict of Interest
R. d’Arby Toledano, Hannah E. Madden and Lisa Leffert declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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