Specific features of anaesthesia in pregnancy

Za što veću uspješnost i sigurnost zahvata u trudnoći koji uključuju određenu anesteziološku tehniku nužni su poznavanje mehanizama djelovanja anestezioloških lijekova, vještina provedbe određenih anestezioloških postupaka, ali i dobro razumijevanje fiziologije boli, trudnoće i porođaja. Fiziološke prilagodbe na trudnoću počinju već u prvom trimestru i utječu na gotovo svaki organski sustav u organizmu žene; farmakokinetika i farmakodinamika određenih anestezioloških lijekova su izmjenjeni i treba se uzeti u obzir njihov učinak na plod. Osim farmakokinetičkih i farmakodinamskih promjena, fiziološke prilagodbe uključuju promjene dišnog, kardiovaskularnog, hematopoetskog, gastrointestinalnog, urogenitalnog i endokrinog sustava stoga je potrebno uzeti u obzir navedene parametre i temeljito ih razmotriti prije izbora određene anesteziološke tehnike. Najsigurnija i najučinkovitija opstetrička anesteziološka tehnika za majku i dijete je neuroaksijalna analgezija koja uključuje epiduralnu i spinalnu analgeziju; ne-neuroaksijalna i opća anestezija se primjenjuju u iznimnim situacijama. Osim neuroaksijalne anesteziološke tehnike, u obzir dolazi i opća endotrahealna anestezija (kod akutnog apendicitisa ili hitnog carskog reza) koja sa sobom donosi određene rizike za majku i dijete; najčešći rizici uključuju otežanu intubaciju, aspiraciju želučanog sadržaja, promjene uteroplacentarnog krvotoka i razvoj fetalne asfiksije te potencijalno štetno djelovanje anestezioloških lijekova na plod. Navedene promjene u trudnoći utječu na anesteziološku tehniku što opstetričku anesteziologiju čini iznimno osobitom i delikatnom granom anesteziologije i zahtijeva široko znanje, iskustvo i kvalitetnu komunikaciju anesteziologa s trudnicom i s opstetričarima.The best efficiency and safety of medical procedures in pregnancy, whereby a certain anesthetic technique is involved, requires expertness of anesthetic drugs action, skilled performance of particular anesthetic procedures, as well as good comprehension of physiology of pain, pregnancy and delivery. Physiological adjustments in pregnancy start in the first trimester and affect almost every system in the female body. The pharmacokinetics and pharmacodynamics of certain anesthetic drugs are changed, so their effect on the fetus should be considered. Apart from the pharmacokinetic and pharmacodynamic changes, physiological adjustments include the changes in respiratory, cardiovascular, hematopoetic, gastrointestinal, urogenital and endocrine systems, so the above mentioned parametres should be considered in detail before choosing a particular anesthetic technique. For the mother and the baby the safest and most efficient obstetric and anesthetic technique is neuroaxial analgesia, which includes epidural and spinal analgesia; while non-neuroaxial and general anesthesia are applied in extraordinary situations. Apart from neuroaxial anesthetic technique, general endotracheal anesthesia is appliable (i.e. in acute apendictis or urgent C-section), which is risky for the mother and the baby. The most frequent risks include complications while intubation, aspiration of gastric content, changes in uteroplacental bloodstream and development of fetal asphyxia and potentially harmful effect of anesthetic drugs on the fetus. The mentioned changes in pregnancy affect anesthetic techniques, which is the reason why obstetric anesthesia is an exceptionally delicate branch of anesthesiology which requires wide knowledge, experience and quality communication between the anesthesiologist, an expectant mother and obstetricians