Anesthesia during pregnancy: possible risks and complications. Anesthesia in pregnant women with surgical non-obstetric pathology Anesthesia for pregnant women during surgery

2% of pregnant women experience situations where they require surgery under anesthesia. There may be plenty of reasons for this: appendicitis, cholecystitis, ovarian cysts, bone fractures, dental diseases.

Some operations can be performed under local anesthesia, while for others only general anesthesia is suitable. Does anesthesia have a negative effect on the fetus, and what negative consequences can there be for the embryo?

Surgeons performing an operation on a pregnant woman

Any surgical interventions, as well as pain relief, in pregnant women are carried out only for emergency reasons, when there is a direct threat to the life of the mother. If there is a possibility of undergoing surgery, it is more advisable to wait until childbirth and then have surgery.

For pregnant women, it is preferable to have surgery under local anesthesia, although it also has some side effects.

Safety of anesthesia for a pregnant woman

It has been statistically reliably established that the frequency of complications from anesthesia in pregnant women, including the most dangerous (anaphylactic shock and death), does not differ from the frequency of such complications in non-pregnant women.

In many ways, the safety of a pregnant woman during surgery depends on the qualifications of the anesthesiologist and on the provision of the operating room with the necessary equipment. The equipment standard includes:

• anesthesia machine with artificial lung ventilation function;
• a monitor that allows you to continuously monitor the most important vital parameters during surgery (blood pressure, pulse and respiration rates, degree of blood oxygen saturation);
• infusion pumps, which are used to continuously administer drugs into a vein;
• defibrillator

Operating room equipment

In the absence of this equipment, the life of a pregnant woman and her unborn child is exposed to unjustified risk.

Safety of anesthesia for the fetus

Risk of anesthesia for the fetus early stages is undeniable and is due to the influence of several factors. The effect of anesthesia used during surgery. Although doctors are now trying to use low-toxic drugs, it is impossible to completely protect the fetus from their influence. The effects of anesthesia are especially noticeable during the first trimester. The miscarriage rate in women undergoing general anesthesia is 3% higher than in the general population (11% versus 8%).

This phenomenon is due to the fact that in the first trimester the formation of the main organs and systems of the fetus occurs, and medications can inhibit this process.

This is interesting! Anesthesia does not increase the likelihood of congenital deformities in a child!

The mother’s hemodynamic state, that is, her pulse and blood pressure. Most anesthesia drugs lower blood pressure, which can have negative consequences for the fetus - blood flow in the utero-placental complex decreases. After anesthesia in pregnant women later(third trimester) risk increases premature birth. This is largely due not to the effects of drugs during anesthesia, but to the stress that the operation itself and the postoperative period pose for a pregnant woman.

During caesarean section Under general anesthesia, a newborn child may experience respiratory depression due to the effects of narcotic anesthetics.

Long-term effects of anesthesia

General anesthesia received during pregnancy does not affect the psychomotor development of the child.

It is safe to say that in women who have undergone general anesthesia during pregnancy, the child will not lag behind its peers in development. Claims that such a child has developmental or mental problems are idle fictions, refuted by numerous scientific studies.

There are also no consequences for the mother, but the benefits of anesthesia during pregnancy are undeniable - with the help of anesthesia, you can completely eliminate the impact of stress and pain on the mother and unborn child.

How can you reduce the risks of anesthesia?

For pregnant women, some emergency operations can be performed under regional, spinal or epidural anesthesia. However, the question of choosing a method of pain relief should be decided together with a doctor, since only he can take into account all the indications and contraindications.

One of the ways to minimize the effect of anesthetics on the unborn child is the use of multicomponent anesthesia, in which drugs are used different groups. This allows the concentration of each of these drugs to be reduced, which reduces their toxic effect.

Caesarean section, which is the most common operation in pregnant women, is currently 80% preferred by doctors to be performed under spinal anesthesia, which completely prevents the entry of anesthesia drugs into the child’s body.

To reduce all negative effects, doctors try to use drugs that do not pass through the uteroplacental barrier. It becomes easier to do this every year, as new, modern anesthetics, including inhalational ones, appear.

How dangerous is anesthesia during pregnancy? Someone was horrified now, because some pregnant women are afraid to take even some medications for headaches, but here is a whole cocktail of various drugs, plus blackout. But, unfortunately, pregnant women require surgery under general anesthesia in 3-4% of cases, so this issue is very relevant.

Indications

Of course, we are not talking about planned surgical interventions that can wait (for example, plastic surgery for the purpose of aesthetic correction of the body). But pregnant women may experience emergencies that cannot be resolved conservatively.

• Complex fractures with displacement.
• Attacks of appendicitis, cholecystitis, pancreatitis.
• Progressive suspicious neoplasms.
• Gynecological problems that interfere with the normal development of the fetus.

For pregnant women, some risks are automatically reduced because they begin to take care of themselves when they learn about their new status as expectant mothers. A woman in an interesting position will switch from heels to comfortable shoes, will temporarily put off extreme sports, and will begin to be more attentive to food and drinks. But not everything depends on it, and you can get into an accident, become a victim of an attack, or even break something just by turning awkwardly.

By the way! Fractures in pregnant women are not uncommon because most of the calcium is given to the fetus to form its skeletal system.

The following situation cannot be ruled out: a woman first planned an operation, and then found out that she was pregnant. What to do in this case? You need to contact the doctor who will be operating to assess the risks and determine whether the intervention can be postponed. If it concerns, for example, the removal of a dangerous tumor, then it is advisable to carry it out rather than worry about it throughout the entire pregnancy.

Harm

Anesthesia is harmful to any person because it is the effect of a mixture of chemicals on the body. But if a healthy, strong man endures general anesthesia relatively calmly and without consequences, then this can cause serious harm to a pregnant woman.

Anesthesia is especially dangerous in the early stages of pregnancy, when all organs and systems begin to form in the fetus. And these processes can be negatively affected by drugs used to put a pregnant woman into medicated sleep. The main risks consist of three factors.

1. Increased uterine tone due to increased pressure. Sometimes this happens even at the preparation stage, because... Some women get too nervous.
2. Fetal asphyxia due to decreased blood pressure and insufficient oxygen entering the blood.
3. Child developmental disorders due to too much exposure to medications. And this is not necessarily an overdose: sometimes the fetus is initially very weak to resist anything.

It is unknown how the body of a pregnant woman will react to the administration of certain drugs. So surgery under anesthesia is always a risk. That's why doctors recommend planning your pregnancy and undergoing pre-pregnancy tests. medical examination for all kinds of diseases requiring surgical treatment.

How to reduce risks

When a pregnant woman is found serious problem, requiring only surgical intervention under anesthesia, she is immediately admitted to the hospital for a full examination and consultation with all doctors, including an obstetrician-gynecologist and an anesthesiologist. At the consultation, a decision is made on the feasibility and necessity of the operation. We also consider all possible options to reduce risks.

Local anesthesia

If it is possible to use spinal anesthesia, the pregnant woman is given this. This type of local anesthesia allows for complex and lengthy operations on the lower extremities and organs of the genitourinary system. At the same time, the patient remains conscious, which means that a harmful “soporific” mixture of gases does not enter her body.

Multicomponent anesthesia

The use of several drugs from different groups can reduce the overall toxic effect. For example, first a pregnant woman will be sedated with sedative intravenous anesthesia, then a mixture of gases will be given, and then medicated sleep will again be maintained with solutions.

Choosing the optimal period

If the problem can wait until the 2nd trimester, the operation is postponed. Because in 4-6 months the fetus is the least vulnerable.

Modern technologies

The development of medicine does not stand still, and new and improved devices and devices for anesthesia and surgical intervention are constantly appearing. And if this clinic does not have such capabilities, the pregnant patient is transferred, for example, to the region or to the capital.

Drugs

For anesthesia during pregnancy, a mixture of drugs is especially carefully selected, which should put the woman into a medicated sleep. Over many years of studying the effects of various solutions, it was found out how certain medications affect pregnant women during anesthesia:

• propofol, glycopyrrolate and morphine are safe in small doses;
• Atropine and metoclopramide are suitable for premedication;
• Thiopental can be used for induction of anesthesia;
• muscle relaxation is achieved by using esmeron;
• maintaining narcotic sleep is carried out using a mixture of sevoflurane plus fentanyl;
• drugs with adrenaline are contraindicated.

The anesthesiologist has an important task: to provide a pregnant woman with a smooth, medicated sleep, during which she will not feel anything physically and be psychologically aware. But at the same time, the anesthesia should not be allowed to be too deep, so as not to increase the concentration of chemicals entering the body.

By the way! The state of anesthesia is maintained by a constant supply of drugs into the body. Therefore, it is important to reduce the duration of the operation as much as possible in order to reduce the impact of chemicals on the woman and the fetus. For this purpose, pregnant women are sometimes operated on by several doctors at once.

Possible consequences

Early anesthesia can lead to fetal death in 11% of cases. But for most women this is not too difficult psychologically, because they have not yet had time to get used to their new status. And physically, the loss of pregnancy also has a slight impact on the patient. She must understand that thanks to the operation, her life is now out of danger, and after some time she will be able to become pregnant again and give birth to a child.

If the operation was performed under anesthesia in the 3rd trimester, the risk of losing the baby is 6%. It's not as much as it seems. In addition, this figure also includes the risks associated with the surgical intervention itself. General anesthesia during the 2nd trimester threatens the death of the child only in 2-3% of cases.

Curious! The percentage of deaths from anesthesia in pregnant women themselves is approximately equal to that of non-pregnant women.

When operating on pregnant women in later stages, there is also a risk of premature birth due to pressure surges and increased uterine tone. Therefore, an obstetrician is often invited to the operation so that he can deliver the child, and a neonatologist who will care for the premature baby.

Thanks to modern technologies and the professionalism of doctors, operations under anesthesia in pregnant women in the vast majority of cases are successful and without consequences for the fetus. The main thing is to contact a specialist immediately after discovering suspicious health problems.

Charles P. Gibbs, M.D.
Professor and Chairman

Joy L. Hawkins, M.D.
Associate Professor
University of Colorado Health Sciences Center
Denver, Colorado 80262

Surgery during pregnancy is not that uncommon. Every year, 0.75-2 percent of pregnant women undergo surgery. In the United States, approximately 75,000 anesthesia procedures are performed annually for this reason 1,2. The most common reasons for surgery are trauma, ovarian cyst, appendicitis 3,4, breast tumors and cervical pathology. We also point out that pregnant patients have successfully undergone craniotomy under controlled hypotension, heart surgery with cardiopulmonary bypass, and even liver transplantation. During all these manipulations, we take care of the safety of both the mother and the fetus. In this regard, it is necessary to remember the following things: 1) some physiological processes in the body of a pregnant woman occur differently; 2) certain anesthetics appear to be teratogenic; 3) during anesthesia, the blood supply to the uterus should in no case be disrupted; 4) anesthesia may adversely affect the fetus; and 5) premature birth is unacceptable, since it is the main cause of death of the child.

Physiological changes during pregnancy

When planning anesthetic care for a pregnant woman, drawing up an anesthesia plan, the anesthesiologist must take into account the physiology of the mother and fetus. Already in the first trimester, there is an increase in cardiac output and circulating blood volume, and by 28 weeks of gestation these indicators are already 30-40 percent higher than those before pregnancy. If a woman is pregnant with twins, her circulating blood volume may increase by 60 percent. By about 30 weeks of gestation, cardiac output increases by 30 percent. This indicator reaches its maximum value immediately after childbirth (increases by 80 percent of the norm), which is associated with autotransfusion of blood from the reduced size of the uterus and the cessation of compression of the abdominal aorta and inferior vena cava; Usually cardiac output returns to its original parameters by 12 weeks postpartum, although this may not occur. Normal blood pressure is maintained by vasodilation. Despite an increase in circulating blood volume and cardiac output, pregnant patients are prone to hypotension in the supine position. Approximately 10 percent of women in late pregnancy may experience symptoms of hypovolemic shock when lying on their back, which occurs due to mechanical compression of the inferior vena cava, which impairs venous return to the heart. Compression of the abdominal aorta does not cause any significant symptoms in the mother, but causes hypotension in the uterine vessels and fetal hypoxia. Therefore, during transportation to the hospital and throughout the entire stay in the operating room, it is necessary to displace the uterus in left side.

The most significant change in pulmonary function during pregnancy is a decrease in functional residual capacity (FRC). Starting from the second trimester, FRC decreases by 20 percent, while oxygen consumption increases by 20 percent. In addition, 30 percent of pregnant women, especially smokers and late-parous women, experience airway closure during normal exhalation when lying on their back. These factors reduce the delivery of oxygen to the body at a time when it is needed in increased quantities, which predisposes to a rapid drop in p02 in the operating room during apnea or a short episode of airway obstruction. All pregnant patients should receive adequate preoxygenation before intubation. The minute volume of ventilation in pregnant women is increased by 50 percent due to an increase in tidal volume; therefore, the normal value of pco2 decreases by 10 mm. rt. Art., which is accompanied by a decrease in bicarbonate concentration. Arterial pO2 values ​​are elevated as alveolar ventilation increases by 70 percent. Throughout the respiratory tract, capillaries are filled with blood, which increases the likelihood of traumatic injury to the airways during manipulations to maintain their patency or during insertion of a tube into the stomach. It is recommended to use smaller endotracheal tubes (6 or 7), avoid nasotracheal intubation, and avoid inserting gastric tubes through the nose.

Pregnant women have an increased risk of aspiration due to both hormonal and mechanical causes. Gastrin levels begin to increase already in the very early stages of pregnancy, which leads to an increase in the acidity of gastric contents, while progesterone reduces the motor activity of the gastrointestinal tract. An enlarged uterus displaces the pyloric section of the stomach, which disrupts the process of emptying it and leads to dysfunction of the pyloric sphincter. The symptom of “burning pain in the heart” indicates the presence of reflux, which occurs due to a decrease in the pressure gradient on opposite sides of the pyloric sphincter; it averages about 7 mm H 2 O ( for comparison, normally the pressure gradient is 28 mm H 2 O). In the preoperative period, all pregnant patients should be prevented from aspiration using nonspecific antacids, as well as H2 blockers and metoclopramide (Cerucal).

Neurological changes that occur during pregnancy become a factor due to which the minimum alveolar concentration (MAC) of inhalational anesthetics decreases by 25-40 percent. Loss of consciousness can occur even when inhaling “sedative doses” of inhaled drugs. In addition, the need for local anesthetics when administered epidurally and subarachnoidally is reduced by 30 percent, probably due to the effect of progesterone on the sensitivity of the nerve fiber. In the epidural space, local anesthetics spread more widely, which becomes noticeable already in the first trimester of pregnancy, and this phenomenon is caused more by hormonal factors than by mechanical factors (mechanical factors include, for example, dilation of the veins of the epidural space due to compression of the inferior vena cava) .

Oxygenation of the fetus depends on the amount of oxygen in the mother's blood and is directly proportional to the intensity of uterine blood flow. Hyperventilation and alkalosis lead to a shift in the maternal oxyhemoglobin dissociation curve to the left, which causes an increase in the affinity of hemoglobin for oxygen in the mother's blood, so the fetus begins to receive less oxygen. With continuous positive pressure ventilation, there is a decrease in venous return to the heart, which can cause a 25% reduction in uterine blood flow. Any episode of maternal hypotension, regardless of its cause, can cause fetal asphyxia.

Teratogenicity and safety of anesthesia drugs

What should an anesthesiologist tell a pregnant patient before surgery about the side effects of anesthesia drugs on the fetus? Can an anesthesiologist convince his patient? Serious birth deformities occur at a rate of 3 percent in the general population, but the exact cause or mechanism of a particular deformity can be identified in less than 50 percent of cases 5 . Although anesthesiologists are often asked the question about the teratogenicity of the drugs they use, there is often no consensus and it is sometimes impossible to achieve it. However, the problem of teratogenicity is based on several overarching principles, familiarity with which helps determine the anesthesia plan.

The potential teratogenicity of a drug is influenced by factors such as: 1) timing of drug administration, 2) individual patient sensitivity to the drug, 3) number of drug administrations, and 4) overall incidence of congenital anomalies with the drug. When prescribing teratogenic agents, it is necessary to remember that the fetus is most vulnerable in the 15-90 days of gestation, when the processes of organogenesis occur (Figure 1). The processes of organogenesis are completely completed by the 13th week of gestation; after this time, the main teratogenic effect is expressed in delayed fetal development or the occurrence of functional disorders; gross anatomical defects are less common. Different organs are vulnerable at different times.

The periods of maximum sensitivity of organs to the effects of teratogenic drugs during the period of organogenesis are as follows: for the brain this is 18-38 days of gestation; for the heart - 18-40 days; for visual organs - 24-40 days; for limbs - 24-36 days; for the genitals - 37-50 days.

Drugs can cause specific defects if they are prescribed during the above critical periods of organogenesis, but during other periods of gestation they may not have any pathological effect. Different genotypes show different sensitivity to the effects of teratogenic factors. Children of chronic alcoholics are born with multiple manifestations of fetal alcohol syndrome. 6,7 In addition, there is a certain threshold below which small amounts of the drug are not teratogenic, although higher concentrations may cause congenital anomalies. In any population there is a certain number of congenital deformities, regardless of the effect of certain medications. For example, if 1 million women take acetaminophen (paracetamol) during pregnancy, 30,000 of their children will have other abnormalities that are not related to acetaminophen.

The incidence of developmental anomalies is also influenced by medical and social factors. Congenital anomalies in children born to mothers with diabetes occur in 4-12 percent of cases. Recent studies have found that careful monitoring of glucose levels before implantation of a fertilized egg and throughout pregnancy can reduce the incidence of congenital anomalies to 1.2 percent. 8 Cocaine and heroin abuse lead to microcephaly and other abnormalities of fetal brain development. 9-11 What teratogenic drugs the father took is also of great importance. The offspring of men who abuse cocaine have an increased risk of congenital abnormalities. 12 Cocaine penetrates sperm and can enter the egg during fertilization, causing disruption of normal fetal development. Before any drug, including anesthetics, is classified as teratogenic, it is necessary to carefully assess the possible influence of all the above-mentioned factors.

The study of teratogenicity and abortogenicity of drugs used in anesthesiology occurs in three directions: 1) experiments on small animals ( For example, Sprague-Dawley rats and chick embryos), 2) epidemiological surveillance of operating room personnel and dentists, i.e., individuals who are constantly exposed to subnarcotic doses of inhalational anesthetics, and 3) follow-up studies in women who during pregnancy underwent surgical intervention.

Experiments on small animals

Such studies are difficult to implement in practice and even more difficult to interpret their results. Teratogenic effect in different types animals is expressed differently, and the data obtained during experiments do not always make it possible to predict the possible effects of certain drugs on the human body. For example, thalidomide causes one or two defects in rodents, although the same drug has proven to be highly teratogenic in humans. Experiments in which rodents or chick embryos are placed for long periods of time in an environment with a high concentration of inhalational anesthetics do not accurately simulate the true conditions that exist in the operating room. Researchers may not be able to monitor blood pressure, temperature, ventilation parameters, oxygenation, or blood sugar levels - indicators that are normally closely monitored by anesthesiologists. For example, if sedation or anesthesia prevents a test animal from feeding normally, it may develop hypoglycemia. It is difficult to determine whether physical defects at birth are the result of the drug itself, or whether they arise under the influence of physiological changes induced by the general anesthetic. Despite everything, experiments on small animals are beneficial and must be continued, since otherwise obtaining information about the teratogenicity of drugs would require conducting studies on a large number of pregnant women. Such studies are quite difficult to conduct, and sometimes they are completely impossible.

Experiments on small animals have already established the safety of some drugs. The safety of opioids is beyond doubt. Morphine 13 , fentanyl 14 , sufentanil 15 and alfentanil 15 have not been shown to have any adverse effects side effects, even if used in very large doses. Children of women who abuse drugs often exhibit delayed physical development, although in this risk group congenital anomalies at birth are observed with the same frequency as in children born to healthy mothers. 10 Studies have established the safety of other intravenous drugs, such as thiopental, methohexital, etomidate, and ketamine. 16

In 1975, it was first reported that taking diazepam during pregnancy increased the incidence of cleft lip in children. 17 Further studies could not confirm this fact; moreover, it turned out that in addition to diazepam, these women took other teratogenic drugs and abused alcohol. 18 However, the leaflet on the use of benzodiazepines, including midazolam, contains the following warning: “Some studies have found that taking benzodiazepines (diazepam and chlordiazepoxide) during pregnancy increases the risk of congenital anomalies in infants. Therefore, before using drugs from this group during pregnancy, your patient should be advised of the potential for adverse effects of these pharmacological agents on the fetus.” 19 The anesthesiologist must clearly determine whether the use of benzodiazepines is justified in a particular clinical situation.

Studies have found that inhalation of halothane, enflurane or isoflurane during gestation for 6 hours a day for three days at doses of 0.75 MAC (which is 0.8 percent for halothane, 1.05 percent for isoflurane or 1.65 percent for enflurane) does not have a teratogenic effect. 20 The use of lidocaine before conception and throughout the entire period of pregnancy in doses up to 500 mg/kg/day does not have a teratogenic effect and does not affect reproductive functions. 21.22

Nitrous oxide

There is still controversy among anesthesiologists about the appropriateness of using nitrous oxide in early pregnancy, and some scientific centers recommend against its use. 23 Their recommendations are based on the fact that nitrous oxide can inhibit methionine synthetase (MS), which could potentially interfere with DNA synthesis in a rapidly growing fetus. Recent studies in Sprague-Dawley rats have found that a 24-hour inhalation of 75 percent nitrous oxide on day 9 of gestation resulted in a fourfold increase in the incidence of “pregnancy resorption” (which is the equivalent of miscarriages in humans), a sevenfold increase in the incidence of organ abnormalities, and delayed pregnancy loss. formation of the musculoskeletal system. 24 Such a dosing regimen of nitrous oxide is extremely rare in non-experimental conditions; in addition, the researchers did not monitor the functioning of the cardiovascular and respiratory systems and carried out inhalation of nitrous oxide during the critical period of gestation. Among other things, the rats did not eat any food during the inhalation of 75 percent nitrous oxide. However, this experiment has brought renewed attention to the issue of the use of nitrous oxide (N2O) during pregnancy in humans. Inhalation of N 2 O causes time- and dose-dependent dysfunction of the bone marrow and megaloblastic anemia, similar to that that develops with vitamin B12 deficiency. This was first described in patients with convulsive syndrome, who were ventilated and sedated using N 2 O. 25-27 Nitrous oxide inactivates vitamin B 12, which is a coenzyme of methionine synthetase (MS), which causes a decrease in the activity of methionine synthetase and disrupts the synthesis of DNA precursors. 28 The administration of folic acid helps prevent dysfunction of the bone marrow, 29 on the basis of which it has been suggested that a decrease in methionine synthetase activity is one of the reasons for the teratogenic effect of nitrous oxide.

Further experiments on Sprague-Dawley rats showed that the activity of MS in the fetus is normally 50 percent of the activity of this enzyme in the mother animal. 30 Inhalation of nitrous oxide resulted in a time- and dose-dependent suppression of metabolic syndrome activity even when the concentration of nitrous oxide was only 7.5 percent. 31 However, the teratogenic effect of nitrous oxide was realized only when its concentration exceeded 25 percent. 32 In other words, inhibition of MS activity was observed at concentrations of nitrous oxide less than 10 percent, while the teratogenic effect of this drug was realized at concentrations of 25 percent or more. Other data also did not support the assumption that the teratogenic effects of nitrous oxide develop due to inhibition of methionine synthetase. Initial experiments were carried out under fairly specific conditions: fetal abnormalities were found with inhalation of 75 percent nitrous oxide for 24 hours, although this dosing regimen is never actually carried out in the operating room. On the other hand, repeated 8-hour inhalations of nitrous oxide during other periods of gestation did not cause any side effects. 35 Such contradictions have forced some researchers to search for other mechanisms through which the side effects of nitrous oxide on the fetus are realized.

Because suppression of MetS activity impairs folic acid metabolism, some researchers have pretreated animals with folic acid (and again given 24-hour inhalation of 75% nitrous oxide on day 9 of gestation). 34 Survival (miscarriage rates) was similar in the two groups of animals, and the incidence of gross musculoskeletal malformations increased fivefold, from 8.4 percent in the control group to 41.3 percent in the group of animals that received nitrous oxide without folic acid . However, the incidence of abnormalities in the folic acid group was 19.1 percent, which is not much different from the control group. In this regard, some research centers began to prescribe folic acid preparations before surgery to women who are planning to undergo general anesthesia during pregnancy. Recent human studies have shown that administration of folic acid before and after fertilization of the egg leads to a reduction in the incidence of neurological defects in the fetus. 35 For this reason, the United States Public Health Service recommends that all women of childbearing age take folic acid supplements daily.

The data obtained from experiments on rodents is quite difficult to interpret in relation to humans. The two studies below cast doubt on the relevance of the methionine synthetase data in humans. The first study measured MC activity in human placental tissue following cesarean sections performed using nitrous oxide. 36 It was found that in this case, the activity of MC was no different from the level of activity of the same enzyme in the placenta after normal vaginal delivery without the use of nitrous oxide. Since nitrous oxide does not affect MS activity in the human placenta, it is unlikely to inhibit MS in human fetal tissue. A second study measured the rate of MS inactivation in women undergoing laparotomy using 70% nitrous oxide. 37 It turned out that the enzyme activity decreases by half within 46 minutes, but in rats this happens in just 5 minutes. Therefore, it is believed that nitrous oxide has no harmful effects in humans if inhaled for less than 45 minutes.

Disagreements regarding the use of nitrous oxide become significantly less when the problem of biochemical disorders (decreased MS activity) and adverse effects on reproductive processes (miscarriages and congenital anomalies) begin to be considered by specialists each separately. The biochemical theory is based on the assumption that the adverse effects of nitrous oxide on reproductive processes are the result of a decrease in the activity of metabolic syndrome, as a result of which the metabolism of folic acid is disrupted and the processes of DNA synthesis are distorted. However, this does not take into account the fact that disruption of biochemical processes (decreased MS activity) occurs even with inhalation of extremely low doses of nitrous oxide (0.75 percent) for a short period of time (5 minutes), and teratogenic effects are realized within 24 hours. inhalation of nitrous oxide in high concentrations.

There is another theory that considers the effect of nitrous oxide on the tone of the sympathetic nervous system. As is known, nitrous oxide increases the tone of the sympathetic nervous system and causes vasoconstriction. The addition of halogenated general anesthetics to the inhalation mixture of nitrous oxide makes it possible to completely avoid congenital malformations and cases of “resorption of pregnancy,” although the activity of metabolic syndrome in both groups decreases by the same amount. 38,39 The sympatholytic effects of halothane and isoflurane appear to reduce sympathetic hyperactivity caused by nitrous oxide, allowing adequate blood flow through the uterus to be maintained. In this study, the protective effect of folic acid was not confirmed, which gave the right to its developers to declare that there is no need to prescribe folic acid supplements to pregnant women whose general anesthesia is planned to be carried out using nitrous oxide. Researchers argue that teratogenicity is due to the fact that nitrous oxide increases the tone of the sympathetic nervous system and reduces uterine blood flow. A decrease in methionine synthetase activity is unlikely to be the only, much less the main, factor explaining the teratogenic effect of nitrous oxide.

Some retrospective human studies have assessed the effects of nitrous oxide in early pregnancy and concluded that the drug does not cause any side effects associated with its use. 40-41 Crawford and Lewis state that “...we believe that the view that women in the first and second trimesters of pregnancy should not inhale nitrous oxide without first administering folic acid is unjustified and causes unnecessary stress and anxiety among women of childbearing age.” age and their medical representatives.” 40 Even in cases where oocyte retrieval for subsequent artificial insemination in vitro was carried out under anesthesia using nitrous oxide, the frequency of chromosomal abnormalities and the index of successful fertilization remained unchanged. 42

Data on the use of nitrous oxide can be summarized as follows. First, nitrous oxide may have a teratogenic effect in animals, which is most likely due to a decrease in uterine blood flow rather than inhibition of methionine synthetase activity. The use of halogenated general anesthetics helps prevent a decrease in uterine blood flow. Second, some studies do not show that folic acid is protective, although daily maintenance doses of folic acid do reduce the overall incidence of neurological defects at birth. And third, despite the fact that nitrous oxide can cause teratogenic effects in animals under certain dosage regimens, nitrous oxide has not been proven to be teratogenic in humans.

The effect of anesthetic agents on personnel in the operating room

An alternative way to study the effects of anesthetics during pregnancy is to study the effects of inhalational anesthetics on operating room or dental personnel. The atmospheric air in the dental office and operating room is contaminated with vapors of gaseous anesthetics; In the literature, there is evidence that women working in such conditions are more likely to have miscarriages, and their children are more likely to have congenital anomalies. 43,44 A recent study sought to examine the effects of high concentrations of nitrous oxide on women working in dentistry; It turned out that this category of people had a significantly reduced reproductive function, which was assessed based on counting the number of menstrual cycles required for pregnancy. 45

However, retrospective studies may be subject to methodological errors. For example, one study found that the rate of spontaneous miscarriage among members of the population who do not encounter inhalational anesthetics in their daily lives was 31 percent. 46 In contrast, many studies of the harmful effects of inhalational anesthetics on health care personnel report significantly lower spontaneous miscarriage rates (3.5–10.5 percent) in control groups. This may be partly due to the fact that women whose work involves contact with inhalational anesthetics are aware of harmful effects the latter on the reproductive function of the body and better understand what consequences this can lead to. Another weakness of retrospective studies is the lack of strict criteria determining the nature or duration of anesthetic effects, as well as their concentration (these criteria vary greatly, depending on several factors, For example on the range of tasks within the competence of this specialist ( For example one doctor specializes in performing mask anesthesia, the other performs regional blockades), the anesthetic equipment used, the effectiveness of cleaning systems). All this complicates the process of creating a representative control group of subjects. Researchers may not take into account other factors such as stress, radiation exposure, maternal age, smoking, obstetric history, and comorbidities such as diabetes.

In our review of studies published before 1985, we found a large number of inaccuracies in study designs. 47 Among them are the lack of clear criteria for the duration and nature of the effects of anesthetics, underestimation of the influence of potential associated factors, and much more. Some authors of these studies have concluded that there is insufficient evidence to suggest that exposure of operating room personnel to inhalational anesthetics results in an increase in spontaneous miscarriages or congenital anomalies.

In later work, an attempt was made to eliminate previous shortcomings, and as a result it was found that in women whose professional activity is related to work in the operating room, the likelihood of miscarriage and the occurrence of congenital anomalies in the child does not increase, the risk of having children with underweight does not increase, and there is no increase in perinatal mortality. In one such study, the study involved nurses working in the operating room who had experienced miscarriages or fetal abnormalities; As a result, it turned out that in this category of people the nature of the action and dose of inhalational anesthetics were no different from those that affected nurses constantly working in the operating room and giving birth normal newborns children. 48 Another study compared the stress levels of nursing staff in an operating room with those of nurses in a regular medical ward; It turned out that the frequency of miscarriages, fetal anomalies and the level of perinatal mortality in the compared groups were the same. 49 Nowadays, operating rooms are widely equipped with air filtration and purification systems, and therefore there is little reason to believe that constant contact with inhalational anesthetics in the operating room poses a health hazard during pregnancy.

Consequences of surgery during pregnancy

Surgery during pregnancy increases the risk of miscarriage. 50,51 There are several reasons for this; surgical intervention can lead to intrauterine death of the fetus, provoke premature birth or contribute to the occurrence of certain anomalies. No studies have established a direct link between surgery and the occurrence of congenital anomalies, but there is convincing evidence that fetal anomalies (often incompatible with life) are often the main cause of premature birth. What is the cause of fetal death - unfavorable preoperative background, surgical aggression or anesthesia? Some studies have examined follow-up data from women who underwent surgery during pregnancy; these works were aimed at establishing the causes of fetal death.

One such work was carried out in Canada, where health insurance contracts for the period 1971-1978, concluded by various insurance companies with more than 2,500 women who underwent surgical interventions during pregnancy, were retrieved from the archives; the data obtained were compared with the results of a survey of the same number of patients whose pregnancy proceeded smoothly, without surgery. 52 As a result, it was found that the risk of congenital anomalies does not increase, but the risk of spontaneous miscarriage increases in those women who underwent surgery under general anesthesia in the first or second trimester of pregnancy (risk score was 2 for gynecological interventions and 1.54 for operations on other organs). The risk of miscarriage did not increase in the group of women who did not receive any general or local anesthetics during pregnancy and who did not undergo a spinal block. The authors of the work concluded that surgery has a significant impact on the course of pregnancy, especially when it is performed on reproductive organs, and general anesthesia itself is a risk factor. 53

Even more comprehensive work was carried out in Sweden, where 5,400 pregnant women who underwent surgery were examined between 1973 and 1981. 2 Again, studies have shown that surgery during pregnancy is not associated with an increased incidence of congenital anomalies; however, it appears that perinatal mortality rates are increasing and low birth weight (less than 1,500 grams) babies are being born more often, even if the surgery was performed well before birth. No analgesic method has been identified as presenting a particular risk to the fetus. On the contrary, the risk of any undesirable consequences during general anesthesia was even below, than it was assumed, which gave the authors grounds to talk about the “protective effect” of general anesthesia. The researchers concluded that the disease that caused the surgery is the main factor influencing the course of pregnancy. Since nitrous oxide was used in 98 percent of general anesthesia, the authors concluded that nitrous oxide was neither toxic nor teratogenic. In a smaller subgroup of patients who underwent appendectomy during pregnancy, similar results were obtained - the risk of congenital anomalies does not increase, and the frequency of spontaneous miscarriages increases during the first week after the operation. 54

Unfortunately, none of these studies allowed us to establish exact reason miscarriages. Preterm birth in the postoperative period (which is identified in the above-mentioned studies as the main cause of fetal death) was most likely due to the presence of an unfavorable premorbid background before surgery and was not associated with the use of any anesthetic, a particular method of anesthesia, or a particular technique. operations. Intra-abdominal pathology, pathology of the pelvic and uterine organs pose the highest risk during pregnancy.

To summarize all that has been said, we note that not a single drug used in anesthesiology, with the exception of cocaine, has so far been designated as having a teratogenic effect in humans. Table 1 lists drugs classified as teratogenic by the American Association of Obstetricians and Gynecologists. 5 Please note that this list does not contain any anesthetics other than cocaine, which will be of interest to those anesthesiologists who specialize in providing pain management to women during pregnancy. However, it must be remembered that hypoxia 55, hypercapnia and hypotension (impairing uterine blood flow) contribute to the occurrence of developmental abnormalities and can lead to fetal death at any stage of gestation.

Carrying out anesthesia in patients with surgical pathology during pregnancy

Preoperative examination

Tables 2 and 3 present the basic principles of patient management in early and late pregnancy. The choice of the most adequate method of pain relief is made taking into account whether pregnancy has been verified in a particular patient with surgical pathology. An anesthesiologist, when visiting his patient of childbearing age in the preoperative period, in all cases is obliged to inquire whether she is pregnant. If there is any doubt, a pregnancy test should be performed. Unpublished data suggests that only about 10 percent of anesthesiologists and surgeons are interested in the date last menstrual period(DPM). 56 The anesthesiologist is required to indicate the DPM in the medical history.

If possible, elective surgical intervention should be postponed until the second or third trimester of pregnancy in order to protect the fetus from exposure to anesthetics during the period of organogenesis (up to the 13th week of gestation). One study examined the risk of cholecystectomy during pregnancy, 57 with nine patients undergoing surgery for cholecystitis on different dates pregnancy. In three of them the operation was performed in the first trimester; In two women, miscarriage occurred shortly after surgery, and in one, spontaneous termination of pregnancy occurred 3 weeks after surgery. Three patients were operated on in the third trimester of pregnancy; in two of them the birth was premature and occurred shortly after the operation, in one patient the birth was urgent. The last three patients underwent surgery in the second trimester of pregnancy, and all of them gave birth to healthy babies at term. These data may indicate that when surgery is performed in the second trimester of pregnancy, the risk of premature birth is lower than when surgery is performed later in pregnancy, since in later periods of gestation the uterus becomes more susceptible to the effects of various irritants.

During the preoperative assessment, the anesthesiologist and surgeon discuss whether surgery may cause spontaneous premature termination of pregnancy and what risk it poses to the fetus; In addition, the patient should be reassured that the anesthetics or pain relief techniques used will not cause significant harm to the fetus. Use effective premedication regimens that sufficiently reduce anxiety, make the mother feel more comfortable, and also prevent the release of endogenous catecholamines, which can reduce uterine blood flow. Opioids and barbiturates can be used safely even in early gestation. If the clinician intends to use benzodiazepines, he or she should first become familiar with the contents of the accompanying package insert. Having decided to use agents that reduce salivation, it is necessary to remember that glycopyrrolate does not have a compromising effect on the hemodynamics of the maternal body; in addition, neither atropine nor glycopyrrolate have any side effects for the fruit. 58 In the preoperative period, it is necessary to prevent aspiration complications. using for this purpose a combination of a nonspecific antacid, an H2 receptor blocker and metoclopramide (cerucal). The administration of paracetamol helps reduce the rate of gastric emptying in the first trimester of pregnancy. 59

For preventive purposes, the obstetrician may prescribe tocolytic (labor-reducing) drugs. For this, suppositories with indomethacin are most often used; The anesthesiologist, as a rule, does not participate in such purely obstetric activities. 60 However, before administering β-agonists or magnesium sulfate, their effects on hemodynamics and interactions with anesthetic drugs should be assessed. The patient needs to be told about the symptoms of preterm labor, such as back pain, since in the postoperative period this makes it possible to detect the onset of preterm labor at an earlier date. Finally, if the gestation is greater than 20 weeks, strongly encourage your patient to lie on her left side during transport to the operating room to avoid compression of the inferior vena cava and abdominal artery.

Carrying out anesthesia

During the operation, it is mandatory to monitor the mother's blood pressure, oxygenation (based on FI O2 and pulse oximetry), ventilation (preferably based on end-tidal CO 2) and temperature. Try to avoid hypoglycemia. After the 16th week of gestation, if possible, use an external Doppler sensor to measure the fetal heart rate and a tocodynamometer to measure uterine contractility, if the place of their attachment does not interfere with the operation. 61 In cases where surgery is performed on the abdominal and pelvic organs, the Doppler sensor, after preliminary sterilization and wrapping, is fixed in a special way, which makes it possible to monitor fetal heart sounds.

The anesthesiologist must explain to surgeons and obstetricians why such close monitoring of the fetus is carried out during surgery. Observation is Not aims to determine when and how labor will begin, as happens in obstetric practice when dealing with a patient giving birth. Monitoring the vital functions of the fetus allows you to once again make sure that the environment existing inside the uterus is optimally suitable for the fetus. For example, a slowing of the fetal heart rate during surgery may indicate unintentional maternal hypoxia, which can be corrected by increasing FI O2 or repositioning the endotracheal tube. 62 Most likely, it is hypoxia that is the most stressful factor for the fetus during the operation and itself. common cause occurrence of developmental anomalies. A slow fetal heart rate may also indicate inadequate uterine blood flow, which can be increased by increasing lateral displacement of the uterus to the left or by increasing mean maternal blood pressure using infusion or pressor drugs (such as ephedrine). In cases. when the operation is performed under controlled hypotension or accompanied by cardiopulmonary bypass, it is the fetus that is the most reliable monitor to assess the adequacy of blood flow in the mother’s body. 63 Opioids, barbiturates, and other anesthetics can cross the placental barrier and affect the fetal heart rate during surgery. This can continue in the postoperative period until these drugs are completely excreted from the fetal body (the mother’s body is usually freed from them at an earlier date). 64 In this regard, assessing the condition of the fetus in the postoperative period is sometimes a difficult task.

There is no reason to believe that any specific drug or particular anesthetic technique is superior to others as long as maternal tissue perfusion (blood pressure and cardiac output) and oxygenation are maintained within normal limits. In other words, it is necessary to try by all means to avoid hypoxia and hypotension. When performing anesthesia, try to think first of all about its safety, and not about which drugs or techniques will be most appropriate. Decreased maternal blood pressure, mechanical ventilation, 65 pain or anxiety, increased uterine activity, and use of vasoconstrictors, 66 all lead to decreased placental blood flow.

Ideally, the administration of general anesthetic begins 5 minutes after the onset of preoxygenation, which helps prevent a rapid decrease in saturation. The rapid sequence induction technique combined with cricoid pressure reduces the risk of aspiration. If ketamine is used as the main anesthetic for induction, then in early gestation it is administered in doses of less than 2 mg/kg to prevent increased uterine tone. 67,68 Ketamine does not increase uterine tone in late pregnancy. Inhalational anesthetics are usually used to reduce uterine tone and contractility. This is especially desirable when performing various manipulations on the abdominal and pelvic organs, but it has not yet been proven that the use of inhalational anesthetics can reduce the incidence of preterm birth. When halogenated anesthetics are used in doses of 2 MAC or higher, there is a decrease in blood pressure and cardiac output in the mother, which leads to acidosis in the fetus. 69,70 Due to the fact that nitrous oxide may reduce uterine blood flow 38,39 and reduce the activity of methionine synthetase, some scientific centers recommend refraining from its use in the first trimester of pregnancy or prescribing folic acid for prophylactic purposes in the preoperative period. 33 As stated earlier, there is no convincing evidence to justify such recommendations, and some animal studies have shown that all unwanted effects Nitrous oxides can be neutralized by adding an inhalational anesthetic. Having decided to eliminate the residual neuromuscular blockade associated with the use of non-depolarizing muscle relaxants, it must be remembered that drugs such as pyridostigmine, neostigmine and edrophonium have a quaternary structure and therefore do not pass through the placenta and do not cause bradycardia in the fetus. However, theoretically, they can increase uterine tone indirectly, as they help increase the release of acetylcholine. These drugs should be administered slowly in combination with an anticholinergic agent such as glycopyrrolate. Summarizing all of the above, we note once again that the features of general anesthesia in pregnant women with surgical pathology are the use of the method of rapid sequential induction, the use of high concentrations of oxygen and acceptable combinations of a narcotic analgesic, an inhalational anesthetic and a muscle relaxant.

The use of various methods of regional anesthesia, especially spinal blockade, is associated with minimal drug exposure to the fetus, which is very important in the first trimester of pregnancy. If no additional sedative or narcotic drugs are administered, then there is no need to talk about their effect on the embryo, and therefore, the condition of the fetus in the postoperative period is fairly accurately assessed by the rhythm of its heartbeats. Adequate pre-infusion load and constant lateral displacement of the uterus to the left side help avoid hypotension. It must be remembered that the need for local anesthetics during pregnancy decreases already in the first trimester. 71 If it becomes necessary to administer a pressor, ephedrine is preferred because it does not affect uterine blood flow, although there are indications that phenylephrine has been successfully used as a pressor in some patients during cesarean section without affecting the fetus. . 72.73

Postoperative follow-up

In the recovery room, monitoring of the fetal heart rate and spontaneous activity of the uterus continues. Sometimes it may be appropriate to entrust this task to a specially trained nurse-midwife. Anesthetics or pain control agents that have not been eliminated from the body in the postoperative period may dull painful sensations associated with uterine contractions, therefore monitoring the contractile activity of the uterus must be continued for at least 24 hours after the end of the operation in order to record the onset of premature labor and begin the necessary preemptive therapy as early as possible. Epidural or intrathecal administration of narcotic analgesics is an excellent method of combating pain in the postoperative period, which does not require additional systemic administration of sedatives to the mother’s body, and therefore the fetal heart rate remains unchanged. The pediatric service must be informed of the surgical intervention and the possibility of premature birth.

ABOUTbeaning

To summarize all that has been said, we note that pregnant patients with surgical pathology must be treated with attention and respect, and not with fear. The likelihood of teratogenic complications when using various painkillers is either extremely small or completely absent. The concept of adequate pain relief during surgical interventions during pregnancy implies high professionalism of the anesthesiologist and a rational, safe approach to any anesthesia, which is more important than the choice of a specific drug or anesthesia technique.

Table 1. Drugs classified as teratogenic

According to statistics, from 3% to 5% of women need surgical treatment while carrying a child. Therefore, anesthesia during early pregnancy is relevant for anesthesiologists. Many expectant mothers are also concerned about this problem.

Any operation and its anesthesia are a stressful situation for the human body, a direct intervention in the biochemistry and physiology of the processes occurring in it. If the operation is performed during pregnancy, the woman worries not only about her fate, but also about the unborn child. What is the likelihood of negative consequences of anesthesia for intrauterine development fetus?

The most dangerous for the fetus are the first 10 - 12 weeks of pregnancy and the last trimester. In the early stages, the formation of organs and systems of the future person occurs, the mother’s body is rebuilt to function in new conditions. The last weeks of pregnancy are dangerous due to the possibility of premature birth and intrauterine fetal death. One of the reasons for such complications may be surgery and the anesthesia associated with it.

Modern medicine has long developed methods to help pregnant women who need surgical intervention. By modern canons, performing an operation in the initial period of bearing a child is possible only if there are emergency indications, if the disease threatens the woman’s life. This may include various injuries, a catastrophe in the abdominal cavity, problems with the urinary system expectant mother. It is considered a separate topic.

The main organ connecting the body of a young woman and the fetus is the placenta. This is where oxygen and nutrients are transferred to the unborn baby, and waste products are excreted. For many medications, one of the characteristics is permeability through the placental barrier; drugs for anesthesia or local anesthesia will not be an exception.

Most drugs used in anesthesiology do not pose a direct threat to the expectant mother and fetus, but their effect on the child’s body depends entirely on the dose and correctness of anesthesia. It is necessary to avoid as much as possible hypotension and hypoxia in a woman during surgery, as this can cause a deterioration in placental blood flow.

Some drugs have historically been considered dangerous during anesthesia in early pregnancy. These include:

• nitrous oxide,
• diazepam,
• sibazon,
• various inhalational anesthetics.

Experts advise avoiding the use of epinephrine during pregnancy, although most local anesthetics for dentistry contain this medication.

Analysis of the work of leading surgical centers allows us to draw the following conclusions about the consequences of anesthesia in pregnant women:

• When performing surgery and general anesthesia in the first 9 - 10 weeks of pregnancy, the probability of intrauterine fetal death increases by 70 - 80% compared to ordinary pregnant women.
• With correct and high-quality anesthesia in early pregnancy, the risk for the unborn child does not exceed 2 - 3% and is almost comparable to the indicators for women who did not undergo surgery during pregnancy.
• The death of a pregnant woman during surgery or anesthesia is half as common as in ordinary patients. This is explained by a more demanding attitude to medical procedures and the high responsibility of the doctor in the event of maternal mortality.

Types of anesthesia for operations in the early stages of pregnancy

When performing surgery in pregnant women, specialists adhere to several basic principles. First of all, the operation is performed only for health reasons; the woman is advised to postpone any planned surgical intervention until after childbirth.

The choice of type of anesthesia is extremely important. In this case, almost everything depends on the volume of the upcoming intervention and the qualifications of the anesthesiologist. Most operations in early pregnancy are currently performed under local or regional anesthesia. Conducting targeted anesthesia allows you to minimize the effect of medications on the body of a woman and her unborn child.

The main methods are spinal anesthesia. In the first case, the anesthetic is injected into the area of ​​the plexus of the spinal cord roots, which causes anesthesia in those parts of the body whose nerve endings have been anesthetized. With the spinal method, drugs are injected directly into the cerebrospinal fluid, which leads to total anesthesia of the entire lower half of the body.

A negative feature of such methods is a possible fall in the expectant mother, which can lead to impaired blood circulation in the placenta and decreased nutrition of the fetus. However, a modern operating room is equipped with a sufficient amount of monitoring equipment, which makes it possible to recognize and eliminate a threat to the health of the mother and child. Even taking into account the possibility of hemodynamic disturbances, regional anesthesia is the method of choice for operations in pregnant women.

The choice of drugs for such pain relief is quite wide. However, anesthesiologists and dentists have to take into account that most local anesthetics contain epinephrine. The use of ultracaine, bupivocaine, lidocaine and other substances requires appropriate skills and experience in providing first aid in the event of the development of any pathological reactions to their administration.

For some operations, regional anesthesia is insufficient, and then anesthesia is given in the early stages of pregnancy. General anesthesia means turning off the consciousness of the expectant mother for the entire duration of the operation in combination with pain relief.

In medical practice, there are intravenous and inhalation types of anesthesia. However, such methods are practically never used in their pure form.

If general anesthesia is required, then in 90% of cases we are talking about multicomponent intravenous anesthesia with mechanical ventilation. The woman is in a state of medicated sleep, breathing is supported by special equipment. The anesthesiologist and his assistants monitor the condition of all organs and systems of the patient throughout the operation.

Even 10 - 15 years ago, preference for operations on pregnant women was given to inhalation anesthesia. The delivery of medications (fluorotane, narcotan and sevoran) was carried out through a face mask. This type of anesthesia was quite manageable, these medicinal substances minimally entered the fetus’s body and did not have a major impact on the unborn child.

However, the risk of vomiting and the entry of stomach contents into the trachea and lungs of the patient, the possibility of developing aspiration pneumonia and quite severe hypotension forced anesthesiologists to reduce this type of anesthesia as much as possible. And the widespread use of nitrous oxide is simply prohibited for use before 14 weeks of pregnancy due to its high toxicity and critical effects on the fetus.

Basic principles of surgery and anesthesia in pregnant women

In the first trimester of pregnancy, or more precisely up to 14 - 15 weeks, the formation of the main organs and systems of the unborn child takes place. Therefore, any external intervention during this important period can lead to catastrophic consequences.

That is why, when performing surgery on pregnant women with a short term, specialists adhere to several basic rules:

Anesthesia in the early stages of pregnancy should not cause fear in the expectant mother. Modern medicine has enough developments and various techniques to provide the necessary assistance to a pregnant woman.

If the expectant mother has an emergency health problem and requires surgery using anesthesia, she must trust the doctors and strictly follow all instructions before and after the operation. In this case, this trouble will not affect your health and will not interfere with the birth of a healthy baby.

Anesthesia, or in medical terms, anesthesia, is an essential part of any surgical operation. As a rule, at least once in his life, a person experiences the effects of anesthesia on himself, even of a local nature. Rarely, but still, the need for anesthesia may arise during the period of bearing a child. In this case, the completely natural question of the safety of anesthesia for the expectant mother and her fetus often arises. Does anesthesia affect the condition of the expectant mother’s body and the fetus? And if it does, how?

According to statistics, the need for anesthesia occurs in approximately two percent of pregnancies. This may be influenced by factors such as surgical operations in the field of traumatology, surgery (appendectomy or cholecystetomy), and dentistry.

Surgery during pregnancy can only be performed when high level threats to the mother's life. If the woman’s health situation is not so serious, surgical interventions are postponed until after childbirth.

Turning to statistical data again and analyzing them, medicine came to the following conclusions:

• among pregnant women who underwent surgical interventions with anesthesia during pregnancy, there is extremely low mortality;
• the risk of developing abnormalities in the child when the mother undergoes anesthesia during pregnancy is also extremely low;
• the probability of a miscarriage after the expectant mother has undergone anesthesia is equal to six percent of the total amount of anesthesia during pregnancy, and this figure is increased to eleven percent in cases of anesthesia in the first trimester of pregnancy, and this especially applies to the first eight weeks of pregnancy;
• The risk of premature birth with anesthesia during pregnancy is approximately eight percent of the total number of cases.

Numerous studies confirm the safety of anesthetics used during pregnancy. Even the negative effects of ancient and dangerous anesthetics such as diazepam and nitrous oxide are now being questioned by leading surgeons in world medicine.

An important role in anesthesia during pregnancy is played not by the choice of drug, but by the method of its introduction into the mother’s body, that is, the technique of anesthesia. When carrying out anesthesia during surgery, it is very important to prevent a woman in position from falling in the level of blood pressure and saturation of her blood with oxygen.

Accidental entry of adrenaline into a blood vessel can cause disruption of the mother's blood flow to the placenta, which, in turn, will negatively affect the supply of oxygen to the fetus. Therefore, many doctors do not recommend the use of local anesthetics containing adrenaline during pregnancy, for example, ultracaine.

From all of the above, we can conclude that anesthesia as such during pregnancy does not cause any particular harm to either the expectant mother’s body or her fetus, and is quite safe event. But, anesthesia with adrenaline can negatively affect the development of the child inside the womb, especially in the first trimester of pregnancy, during the development and formation of fetal organs and systems.

Therefore, the decision on anesthesia during pregnancy should be expedient and made only collectively, taking into account the possible negative impact on the fetus.

If the condition of the expectant mother is tolerable enough to postpone surgery, it is best to decide on anesthesia in the period after the birth of the child. As a last resort, it is better to postpone surgery with anesthesia until the third trimester.

If the question arises about the type of anesthesia, then it is preferable to perform the operation under local anesthesia during pregnancy. If local anesthesia is not possible, regional anesthesia is an alternative. If these two types of anesthesia are not possible, the woman undergoes surgery under general anesthesia. For any type of operation with anesthesia, a gynecologist must be present who will tirelessly monitor the condition of the fetus. And if necessary, when the operation is delayed and there is a threat of premature birth, it will be carried out to save the life of both mother and child.