Anesthesia for nonobstetric surgery: maternal and fetal considerations

This monograph will review and update our understanding of the administration of anesthesia for nonobstetric surgery and its maternal and fetal effects. It begins with a summary of the subject and a short review of maternal physiologic changes during pregnancy with an emphasis on their anesthetic implications. Attention will be paid to a review of the literature and meta-anlyses that crystallize our understanding of fetal vulnerability to teratogenicity and the evidence for and against anesthetic effects in this regard. Recent reports of anesthetic effects on fetal and neonatal rat neural function will be reviewed and commented on. Fertility and pregnancy retention after anesthetic administration will be surveyed and a short update on the risks experienced by operating room personnel exposed to environmental anesthetics will be covered. The question of whether to and when to monitor the fetus during nonobstetric surgery will be discussed with some suggested guidelines. Special surgical situations such as laparoscopy, cardiac surgery, trauma, and fetal therapy will also be discussed. The conclusion contains clinical suggestions for the approach to anesthetizing the pregnant patient.