Anaesthesia, minimally invasive surgery and pregnancy

Minimally invasive surgery is being performed more frequently in pregnant patients. Numerous published reports have documented the safety and advantages of laparoscopic cholecystectomy and laparoscopic appendectomy during pregnancy. Pregnancy is associated with a variety of changes in the respiratory and cardiovascular systems, which make the parturient undergoing laparoscopic surgery particularly susceptible to hypoxia, hypercarbia and hypotension. This chapter provides a review of those physiological changes of pregnancy of particular concern for anaesthesiologists, and of the physiological responses to intra-abdominal carbon dioxide insufflation, not only in healthy patients, but also in the altered physiological state associated with pregnancy. We also describe our approach to anaesthetic management for minimally invasive surgery during pregnancy. With appropriate precautions, including vigilant monitoring and anticipation and treatment of the potential adverse effects of carbon dioxide pneumoperitoneum, anaesthesiologists may provide safe care for these patients, and pregnant women can benefit from the advantages of minimally invasive surgery.