PRINCIPLES OF SAFETY IN ANESTHESIOLOGICAL SUPPORT FOR SURGICAL INTERVENTIONS DURING PREGNANCY. LITERATURE REVIEW.

Abstract

Introduction: Modern medicine faces an urgent need to address the challenges of anesthetic support during nonobstetric surgical interventions in pregnancy, which, according to statistics, occur at a frequency of 0.75% to 2% per year. The specifics of such interventions in the lower abdominal area, including appendectomies, cholecystectomies, and treatment of intestinal obstruction, present unique challenges for anesthesiologists. The significance of this issue is underscored by the increasing cases of maternal mortality from extragenital diseases requiring surgical intervention. The lack of unified research standards in this area, as well as insufficient data on the safety of anesthesia in different stages of pregnancy, highlights the relevance of further scientific research to optimize medical practice and ensure the safety of pregnant patients. Aim: Conducting a comprehensive analysis and assessment of the safety of anesthesia for non-obstetric surgical interventions during pregnancy based on contemporary literature. Search Strategy: In the systematic review of scientific literature on the safety of anesthesia during pregnancy, medical databases such as MEDLINE (PubMed), Scopus, and Cyberleninka were utilized. Inclusion criteria consisted of full-text documents with open access in English and Russian, with a search depth of 10 years, starting from 2013. Despite 15 sources not meeting the inclusion criteria based on publication date, they contained important information on the topic and were therefore included in the analysis. The review encompasses articles from meta-analyses, cohort studies, randomized trials, systematic reviews, and retrospective studies, focusing on anesthetic management and techniques in surgical interventions during pregnancy. The search languages included both Russian and English to account for the diversity of research materials. Exclusion criteria: duplicate data, abstracts of reports, newspaper publications, personal communications. Results and Conclusions: Women undergoing operative interventions during pregnancy have an increased risk of preterm births and low birth weight. However, general anesthesia can be safely applied at different stages of pregnancy, and the choice of anesthesia type is not associated with an increased frequency of adverse outcomes. There were also no clinically significant deviations in neurodevelopment observed in children exposed to prenatal anesthesia during nonobstetric surgeries, emphasizing the relative safety of such procedures. However, despite general conclusions, the need for additional research is expressed, especially in more vulnerable groups of children or specific cognitive areas, to gain a deeper understanding of the potential impact of anesthesia on neurodevelopment.