Anaesthetising the Pregnant Woman

As an obstetric anaesthetist, my work is primarily focused on anaesthetising pregnant women for obstetric procedures, but I am also consulted on anaesthesia for pregnant women presenting for incidental surgery in pregnancy.

The pregnant state demands dramatic physiological compensation to adapt to the requirements of the developing fetus and to prepare for childbirth. These changes are evident from a very early stage in pregnancy and initially seem to be out of proportion to the size of the fetus. Changes are evident in most body systems and anaesthesia in pregnancy must take this into consideration. There are also important pharmacological considerations in the pregnant state, both with the handling of drugs and the choice of drugs in pregnancy.

There are different techniques for anaesthetising women for obstetric procedures and these are broadly divided into regional anaesthesia or general anaesthesia. The choice of anaesthetic technique depends on many factors such as the urgency for delivery, choice of labour analgesia and factors that may be absolute or relative contraindications to regional or general anaesthesia. The majority of obstetric surgical interventions are performed with women awake under either a spinal or epidural anaesthetic. [...]