REMEDIUMREMEDIUM1561-59362658-3534Joint-Stock Company Chicot142210.32687/1561-5936-2022-26-2-132-138Review articleThe issue of medical and psychological risks of anesthesia in obstetricsTliashinovaI. A.-MingazovR. N.mrn85@mail.ruShigabutdinovaT. N.-N. A. Semashko National Research Institute of Public Health1512202226213213820062022Copyright © 2022,2022Anesthesia, being an ethical necessity, is increasingly used in caesarean sections, the number of which is growing in the world, especially against the backdrop of an increase in the number of women in labor of older reproductive age. As an effective method for preventing maternal and perinatal deaths, anesthesia can lead to short-term and long-term health consequences for women and children. A study of the quality of medical care for anesthesia and the level of satisfaction of mothers after caesarean section showed that about 80% of women in labor were satisfied with spinal anesthesia. Of particular relevance are the problems of obstetrics and anesthesia in the context of the COVID-19 pandemic, the choice of anesthesia method for caesarean section is crucial for pregnant women with COVID-19. Neurocognitive complications of anesthesia are mainly caused by exposure to factors of preoperative procedures, as well as the action of adjuvant agents used to enhance the effect of local anesthetics, which are also neurotoxic. Perioperative cognitive impairment most often manifests itself in two main forms: postoperative delirium and cognitive dysfunction. It is necessary to further study the issues of pharmacokinetic characteristics of drugs that determine the level of their passage through the placenta and into mother's milk in the perinatal period and during lactation, their effect on breastfed infants, the risk of inhibition of lactogenesis in women after childbirth, etc. In connection with an increase in childbirth in women of older reproductive age and the use of anesthesia for caesarean section, the question of the effect of anesthesia on the risk in women of early dementia is of interest.anesthesiacaesarean sectionobstetricsneurological complicationscognitive disordersанестезиякесарево сечениеродовспоможениеневрологические осложнениякогнитивные расстройстваHohn A., Machatschek J. N., Franklin J., Padosch S. A. Incidence and risk factors of anaesthesia-related perioperative cardiac arrest: a 6-year observational study from a tertiary care university hospital // Eur. J. Anaesthesiol. 2018. Vol. 35, N 4. P. 266-272. DOI: 10.1097/EJA.0000000000000685Abe H., Sumitani M., Uchida K. et al. Mode of anaesthesia for Caesarean delivery and maternal morbidity: can we overcome confounding by indication? // Br. J. Anesth. 2018. Vol. 120, N 4. P. 779-789. DOI: 10.1016/j.bja.2018.01.002Sato M., Ida M., Naito Y., Kawaguchi M. Perianesthetic death: a 10-year retrospective observational study in a Japanese university hospital //j. Clin. Rep. 2020. Vol. 6, N 1. P. 8. DOI: 10.1186/s40981-020-0314-2Sandall J., Tribe R. M., Avery L. et al. Short-term and long-term effects of caesarean section on the health of women and children // Lancet. 2018. Vol. 392, N 10155. P. 1349-1357. DOI: 10.1016/S0140-6736(18)31930-5Sorrenti V., Cecchetto C., Maschietto M. et al. Understanding the effects of anesthesia on cortical electrophysiological recordings: a scoping review // Int. J. Mol. Sci. 2021. Vol. 22, N 3. P. 1286. DOI: 10.3390/ijms22031286Robbins L. S., Blanchard C. T., Biasini F. J. et al. General anesthesia for cesarean delivery and childhood neurodevelopmental and perinatal outcomes: a secondary analysis of a randomized controlled trial // Int. J. Obstet. Anesth. 2021. Vol. 45. P. 34-40. DOI: 10.1016/j.ijoa.2020.08.007Olutoye O. A., Baker B. W., Belfort M. A., Olutoye O. O. Food and Drug Administration warning on anesthesia and brain development: implications for obstetric and fetal surgery // Am. J. Obstet. Gynecol. 2018. Vol. 218, N 1. P. 98-102. DOI: 10.1016/j.ajog.2017.08.107Chekol B., Getu D., Tesfaw D., Taye M. G. Assessment of satisfaction and associated factors of parturients underwent cesarean section with spinal anesthesia at the General Hospital, Ethiopia // Ann. Med. Surg. 2021. Vol. 65. P. 102282. DOI: 10.1016/j.amsu.2021.102282Yu C., Gu J., Liao Z., Feng S. Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies // Int. J. Obstet. Anesth. 2021. Vol. 47. P. 103175. DOI: 10.1016/j.ijoa.2021.103175Kim W. H., Hur M., Park S. K. et al.Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery: a network meta-analysis // Int. J. Obstet. Anesth. 2019. Vol. 37. P. 5-15. DOI: 10.1016/j.ijoa.2018.09.012Keren A., Akhtar H., Khan A. A. A study on the impact of anesthesia in cesarean section // Am. J. Pharm. Sci. 2019. Vol. 6, N 5. P. 11160-11164. DOI: 10.5281/zenodo.3235383Tanaka H., Kamiya C., Katsuragi S. et al. Effect of epidural anesthesia in labor; pregnancy with cardiovascular disease // Taiwan J. Obstet. Gynecol. 2018. Vol. 57, N 2. P. 190-193. DOI: 10.1016/j.tjog.2018.02.004Orbach-Zinger S., Grant T. G., Zahalka M. et al. A national Israeli survey of neuraxial anesthesia for cesarean delivery: pre-operative block assessment and intra-operative pain management // Int. J. Obstet. Anesth. 2022. Vol. 50. P. 103255. DOI: 10.1016/j.ijoa.2022.103255Kumar R., Singh K., Prasad G., Patel N. Repeat spinal anesthesia after a failed spinal block in a pregnant patient with kyphoscoliosis for elective cesarean section //j. Obstet. Anaesth. Crit Care. 2014. Vol. 4. P. 84-86. DOI: 10.4103/2249-4472.143879Ward V. D. Anaesthesia for Caesarean section in a patient with Parkinson’s disease // Int. J. Obstet. Anesth. 2018. Vol. 34. P. 99-102. DOI: 10.1016/j.ijoa.2017.11.003Nasr S. Impact of COVID-19 on obstetric anesthesia: a systematic review // Ain-Shams J. Anesthesiol. 2021. Vol. 13:70. DOI: 10.1186/s42077-021-00188-wBani Hani D. A., Alsharaydeh I., Bataineh A. M. et al. Successful anesthetic management in cesarean section for pregnant woman with COVID-19. Unusual setting of medical care // Am. J. Case Rep. 2020. Vol. 21. P. e925512. DOI: 10.12659/AJCR.925512Ismail S., Aman A. Safe anesthesia and analgesia for obstetric patients in COVID 19 pandemic //j. Obstet. Anaesth. Crit. Care. 2020. Vol. 10. P. 65-68. DOI: 10.4103/joacc.JOACC_50_20Jain K. K. Neurological complications of anesthesia // Drug-induced Neurological Disorders. Cham; 2021. DOI: 10.1007/978-3-030-73503-6_8Jain K. K. Drug-induced disorders of memory and dementia // Drug-induced Neurological Disorders. Cham; 2021. DOI: 10.1007/978-3-030-73503-6_14Berger M., Schenning K. J., Brown C. H. et al. Best practices for postoperative brain health: recommendations from the Fifth International Perioperative Neurotoxicity Working Group // Anesth. Analg. 2018. Vol. 127, N 6. P. 1406-1413. DOI: 10.1213/ANE.000000000000384Belrose J. C., Noppens R. R. Anesthesiology and cognitive impairment: a narrative review of current clinical literature // BMC Anesthesiol. 2019. Vol. 19, N 1. P. 241. DOI: 10.1186/s12871-019-0903-7Evered L., Silbert B., Knopman D. S. et al. Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery-20181 //j. Alzheimers Dis. 2018. Vol. 66, N 1. P. 1-10. DOI: 10.3233/JAD-18900Aytaç I., Güven Aytaç B., Demirelli G. et al.Comparison of postoperative cognitive decline using the mini-mental state examination and montreal cognitive assessment after minor elective surgery in elderly // Cureus. 2021. Vol. 13, N 10. P. e18631. DOI: 10.7759/cureus.18631Liu J., Huang K., Zhu B. et al. Neuropsychological tests in post-operative cognitive dysfunction: methods and applications // Front. Psychol. 2021. Vol. 12. P. 684307. DOI: 10.3389/fpsyg.2021.684307Kenney L. E., Ratajska A. M., Lopez F. V. et al. Mapping actuarial criteria for Parkinson's disease - mild cognitive impairment onto data-driven cognitive phenotypes // Brain Sci. 2021. Vol. 12, N 1. P. 54. DOI: 10.3390/brainsci12010054Weiss L. G., Saklofske D. H., Holdnack J. A., Prifitera A. WISC-V assessment and interpretation. Scientist-practitioner perspectives. N.Y.; 2015. DOI: 10.1016/B978-0-12-404697-9.00001-7Edipoglu I. S., Celik F. The associations between cognitive dysfunction, stress biomarkers, and administered anesthesia type in total knee arthroplasties: prospective, randomized trial // Pain Physician. 2019. Vol. 22, N 5. P. 495-507.Wang Y., Kong L., Liu X. Effect of epidural block anesthesia combined with general anesthesia on postoperative cognitive ability of elderly patients undergoing thoracoscopic surgery // Int. J. Clin. Exp. Pathol. 2020. Vol. 13, N 10. P. 2447-2454.Evered L. A., Silbert B. S. Postoperative cognitive dysfunction and noncardiac surgery // Anesth. Analg. 2018. Vol. 127, N 2. P. 496-505. DOI: 10.1213/ANE.0000000000003514Lu X., Jin X., Yang S., Xia Y. The correlation of the depth of anesthesia and postoperative cognitive impairment: a meta-analysis based on randomized controlled trials //j. Clin. Anesth. 2018. Vol. 45. P. 55-59. DOI: 10.1016/j.jclinane.2017.12.002Sohn J. H., Lee J. J., Lee S. H. et al. Longitudinal study of the association between general anesthesia and increased risk of developing dementia //j. Pers. Med. 2021. Vol. 11, N 11. P. 1215. DOI: 10.3390/jpm11111215Potkonjak A. M., Djaković I., Sabolović Rudman S. et al. Risk assessment in pregnancy among women aged over forty // Acta Clin Croat. 2021. Vol. 60, N 2. P. 290-295. DOI: 10.20471/acc.2021.60.02.16Correa-de-Araujo R., Yoon S. S. S. Clinical outcomes in high-risk pregnancies due to advanced maternal age //j. Womens Health (Larchmt). 2021. Vol. 30, N 2. P. 160-167. DOI: 10.1089/jwh.2020.886Van der Veeken L., Van der Merwe J., Devroe S. et al. Maternal surgery during pregnancy has a transient adverse effect on the developing fetal rabbit brain // Am. J. Obstet. Gynecol. 2019. Vol. 221, N 4. P. 355.e1-355.e19. DOI: 10.1016/j.ajog.2019.07.029Wilińska M., Walas W., Kamińska E. et al. Do drugs used in obstetric anesthesia interfere with early breastfeeding? Characteristics of the pharmacodynamic and pharmacokinetic properties of certain drugs. Part 2 // Dev. Period. Med. 2019. Vol. 23, N 4. P. 233-244. DOI: 10.34763/devperiodmed.20192304.233244Wilińska M., Walas W., Kamińska E. et al. Do drugs used in obstetric anesthesia interfere with early breastfeeding? What determines drug safety in lactation? Part 1 // Dev. Period. Med. 2019. Vol. 23, N 4. P. 227-232. DOI: 10.34763/devperiodmed.20192304.227232Misra V. Analgesia, Anaesthesia and Pregnancy - a practical guide, fourth edition // Can. J. Anesth. 2020. Vol. 67. P. 628-629. DOI: 10.1007/s12630-020-01576-w