Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000100012
Brazilian Journal of Anesthesiology
Review Article

Passagem transplacentária e efeitos embriofetais de drogas usadas em anestesia

Placental transfer and embryo-fetal effects of drugs used in anesthesia

Márcio Leal Horta; Ione Pellegatti Lemonica

http://dx.doi.org/10.1590/S0034-70942002000100012 Braz J Anesthesiol, vol.52, n1, p.101-113, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: A anestesia da paciente grávida engloba situações diversas e que devem ser analisadas com muita propriedade. Além da exposição do feto e de uma possível ação tóxica dos agentes a serem utilizados na anestesia, devem ser considerados o período gestacional, as características de cada droga e as doses a serem utilizadas. A falta de informações adequadas sobre o risco do uso de drogas na gestação torna difícil ao anestesiologista uma opção segura quando se vê diante da necessidade de anestesiar uma paciente grávida, tanto para cirurgia não obstétrica, como em cirurgia obstétrica. No primeiro caso, é importante evitar o parto prematuro (ou o aborto) e o aparecimento de alterações permanentes no feto. No segundo caso, não deve haver interferência na contratilidade uterina nem depressão significativa no feto. A finalidade desta revisão é atualizar os conhecimentos sobre a passagem transplacentária e os efeitos maternofetais das drogas usadas em anestesia. CONTEÚDO: São revisados os mecanismos de passagem transplacentária de drogas, os princípios fundamentais de embriofetotoxicidade e analisados alguns aspectos importantes sobre efeitos embriofetais das drogas utilizadas na anestesia. Também é apresentada a classificação de risco teratogênico, de acordo com o FDA, das drogas que o anestesiologista mais utiliza durante o ato anestésico. CONCLUSÕES: Embora ainda persistam muitas dúvidas em relação à escolha de drogas para a anestesia de pacientes grávidas, o anestesiologista dispõe hoje de novas drogas e de informações que lhe permitem oferecer maior segurança para o binômio mãe-feto.

Palavras-chave

COMPLICAÇÕES, DROGAS, FISIOLOGIA

Abstract

BACKGROUND AND OBJECTIVES: Anesthesia for pregnant patients has several peculiarities that need to be adequately analyzed. Besides fetus exposure and possible toxic effects of anesthetic agents, gestational age, drug properties and doses should be considered. The lack of adequate information about the risk of using drugs during gestation turns it difficult for anesthesiologists to make a safe choice when facing the need to anesthetize a pregnant patient, both for non-obstetric or for obstetric surgery. In the former case, it is important to avoid premature labor (or abortion) and permanent fetus abnormalities; in the latter, there should be neither interference on uterine contractility nor significant fetus depression. This review aimed at updating information on placental transfer of anesthetic drugs and maternal-fetal effects of anesthetic drugs. CONTENTS: The mechanisms of placental transfer of drugs and the basic principles of embryo-fetotoxicity are reviewed and important aspects of embryo-fetal effects of anesthetic drugs are analyzed. FDA’s classification of drugs most frequently used in anesthesia is presented, according to their teratogenic risk. CONCLUSIONS: There are still many issues involving the choice of anesthetic drugs to be used in pregnant patients, but today there are new drugs and information allowing anesthesiologists to grant greater security to both mother and fetus.

Keywords

COMPLICATIONS, DRUGS, PHYSIOLOGY

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