Paweł Radkowski, Justyna Opolska, Patrycja Bartosiewicz

Effect of anesthetic drugs on the fetus. Literature review
2023-05-25

Anaesthesia during pregnancy or associated with its termination requires special care. Many anaesthetics pass through the placenta, which can adversely affect the foetus. This is due to the good fat solubility of many drugs, as well as other factors affecting transfer across the placenta. There are also limitations to the metabolism of the drug on the fetal side, which can cause adaptation difficulties and respiratory depression, as well as affecting Apgar scores. Other factors affecting placental transfer of anaesthetic drugs are also discussed in this article. It is worth noting that the pharmacokinetics of many drugs are altered in the pregnant woman. The safety of the use of drugs in a pregnant woman is described by the Food and Drug Administration (FDA), which is crucial when considering the effects of a drug on the mother and child. However, in the case of a threat to the life of the mother, a drug from a category not originally indicated for use in pregnant women may be used. In the case of induction of anaesthesia by the intravenous route, the most beneficial drug would be propofol. The use of a low dose of propofol allows a satisfactory adaptation of the baby after birth and a high Apgar score. Nevertheless, the use of propofol in pregnancy should be avoided if it is not necessary. An increasing number of women are using pharmacological methods of pain relief during natural childbirth with perinatal analgesia. Sufentanyl is a good drug for pain relief during natural childbirth because, despite passing through the placenta more rapidly relative to fentanyl, it reaches lower concentrations in the mother’s blood, reducing the risk of respiratory depression in the foetus. Benzodiazepines are drugs that tend to accumulate in the body and can cause „Floppy Infant Syndrome” When using muscle relaxants during pregnancy, the best choice is succinylcholine, a depolarising muscle relaxant that is fast-acting and short-acting. This article presents a table of drugs used in the anaesthesia of the pregnant woman, taking into account the rate of transfer across the placenta, the duration of drug action, possible adverse effects in the foetus and the risk of developing congenital defects.

Keywords: pregnancy, pharmacokinetics, congenital defects, anaesthetics, FDA classification.

© Farm Pol, 2023, 79(1): 33–40