Challenges of anesthesiology in non-obstetric surgical procedures during the gestational period
DOI:
https://doi.org/10.33448/rsd-v11i14.31502Keywords:
Pregnancy; Anesthesia; Congenital abnormalities.Abstract
Non-obstetric surgical interventions in pregnant women, despite having a low incidence, occur, and require further studies regarding the anesthesiological management, due to pregnancy being a period marked by physiological, hormonal and anatomical changes for the mothers, and of great cell differentiation and growth. for embryos and/or fetuses, which their exposure to drugs can be a risk factor for development. The aim of this study is to analyze the implications of anesthetic management in non-obstetric surgeries during pregnancy. This work is a systematic review of the literature, carried out through articles published in English, between 2017 and 2022, published in the PUBMED and VHL databases, with the following descriptors: pregnancy, anesthesia, congenital abnormalities. It was found that: neuraxial anesthesia is more indicated in the first trimester, due to lower toxicity; low fetal weight associated with general anesthesia; most surgeries are abdominal and occurred in the second trimester under general anesthesia; higher prevalence of premature births in pregnant women who underwent surgery in the third trimester; need for surgical planning, anesthetic management and fetal monitoring according to the physiological particularities of each pregnant woman; and brain neurotoxicity proven in animal tests. Anesthesiological planning is essential to minimize the risks of fetal exposure to toxicity and teratogens, however, it is valid to show that anesthetics, provided they are applied in standard dosages, do not present serious risks to the development of the fetus, but in addition to multidisciplinary care, it is essential that new studies are carried out to assess the brain neurotoxicity of these drugs in fetuses.
References
American College of Obstetricians and Gynecologists. (2019). ACOG committee opinion no. 775: nonobstetric surgery during pregnancy. Obstet Gynecol, 133(4), e285-e286.
Devroe, S., Bleeser, T., Van de Velde, M., Verbrugge, L., De Buck, F., Deprest, J., ... & Rex, S. (2019). 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, 39, 74-81.
Freitas, J. A., Carvalho, I. S., Alves, F. B., da Silva Costa, N., & Carvalho, G. A. O. (2021). Biossegurança em procedimentos cirúrgicos odontológicos frente a pandemia do COVID-19. Research, Society and Development, 10(1), e5810111401-e5810111401.
Fuchs, S. C. P. C., & Paim, B. S. (2010). Revisão sistemática de estudos observacionais com metanálise. Revista HCPA. Porto Alegre. Vol. 30, n. 3 (2010), p. 294-301.
Giampaolino, P., Della Corte, L., Sardo, A. D. S., Zizolfi, B., Manzi, A., De Angelis, C., ... & Carugno, J. (2019). Emergent Laparoscopic Removal of a Perforating Intrauterine Device During Pregnancy Under Regional Anesthesia. Journal of minimally invasive gynecology, 26(6), 1013-1014.
Major, A. L., Jumaniyazov, K., Yusupova, S., Jabbarov, R., Saidmamatov, O., & Mayboroda-Major, I. (2021). Removal of a Giant Cyst of the Left Ovary from a Pregnant Woman in the First Trimester by Laparoscopic Surgery under Spinal Anesthesia during the COVID-19 Pandemic. Medical Sciences, 9(4), 70.
Massoth, C., Töpel, L., & Wenk, M. (2020). Hypotension after spinal anesthesia for cesarean section: how to approach the iatrogenic sympathectomy. Current Opinion in Anesthesiology, 33(3), 291-298.
Mayhew, D., Mendonca, V., & Murthy, B. V. S. (2019). A review of ASA physical status–historical perspectives and modern developments. Anaesthesia, 74(3), 373-379.
McKiever, M., Lynch, C. D., Nafiu, O. O., Mpody, C., O'Malley, D. M., Landon, M. B., ... & Venkatesh, K. K. (2021). Racial Disparities in the Risk of Complications After Nonobstetric Surgery in Pregnancy. Obstetrics & Gynecology, 137(2), 236-245.
Moawad, N. S., Flores, E. S., Le-Wendling, L., Sumner, M. T., & Enneking, F. K. (2018). Total laparoscopic hysterectomy under regional anesthesia. Obstetrics & Gynecology, 131(6), 1008-1010.
Lee, M. S., Fenstermaker, M. A., Naoum, E. E., Chong, S., Van de Ven, C. J., Bauer, M. E., ... & Ghani, K. R. (2021). Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center. Frontiers in surgery, 8.
Leffert, L., Butwick, A., Carvalho, B., Arendt, K., Bates, S. M., Friedman, A., ... & Toledo, P. (2018). The Society for Obstetric Anesthesia and Perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants. Anesthesia & Analgesia, 126(3), 928-944.
Lie, S. A., Wong, S. W., Wong, L. T., Wong, T. G. L., & Chong, S. Y. (2020). Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 67(7), 885-892.
Piccioni, M. G., Tabacco, S., Giannini, A., Deroma, M., Logoteta, A., & Monti, M. (2020). Myasthaenia gravis in pregnancy, delivery and newborn. Minerva Ginecologica, 72(1), 30-35.
Pinyavat, T., Saraiya, N. R., Chen, J., Ferrari, L. R., Goffman, D., Imahiyerobo, T. A., ... & Houck, C. S. (2019). Anesthesia exposure in children: Practitioners respond to the 2016 FDA drug safety communication. Journal of Neurosurgical Anesthesiology, 31(1), 129-133.
Po' G, Olivieri C, Rose CH, Saccone G, McCurdy R, Berghella V. Intraoperative fetal heart monitoring for non-obstetric surgery: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2019 238:12-19. 10.1016/j.ejogrb.2019.04.033.
Ravindra, G. L., Madamangalam, A. S., & Seetharamaiah, S. (2018). Anaesthesia for non-obstetric surgery in obstetric patients. Indian Journal of Anaesthesia, 62(9), 710.
Shaw, C. J., Botting, K. J., Niu, Y., Lees, C. C., & Giussani, D. A. (2020). Maternal and fetal cardiovascular and metabolic effects of intra-operative uterine handling under general anesthesia during pregnancy in sheep. Scientific reports, 10(1), 1-8.
Souza, M. D., Silva, M. D., & Carvalho, R. D. (2010). Revisão integrativa: o que é? E como fazer isso? Einstein, 8 (1), 102-106.
Terukina, J., Takamatsu, M., Enomoto, T., & Baba, H. (2017). Anesthetic management of abdominal radical trachelectomy for uterine cervical cancer during pregnancy. Journal of anesthesia, 31(3), 467-471.
Torres, S. M., Duarte, D. F., Glória, A. S., Reis, C., Moreira, J. F., Cunha, S., ... & Dahlem, C. (2021). Sugammadex administration in pregnant patients undergoing non-obstetric surgery: a case series. Brazilian Journal of Anesthesiology (English Edition).
Ramirez, V., Valencia, G., & Catalina, M. (2020). Anesthesia for nonobstetric surgery in pregnancy. Clinical Obstetrics and Gynecology, 63(2), 351-363.
Vujic, J., Marsoner, K., Lipp-Pump, A. H., Klaritsch, P., Mischinger, H. J., & Kornprat, P. (2019). Non-obstetric surgery during pregnancy–an eleven-year retrospective analysis. BMC Pregnancy and Childbirth, 19(1), 1-5.
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