*4.4.1 Anesthetic care*

Before anesthesia, all physiological changes associated with pregnancy must be considered. The effects of pregnancy on mother pulmonary and cardiovascular function must be considered. Adequate precautions should be taken to prevent hypoxemia and aspiration. The magnesium sulfate used in tocolysis may decreases capillary oncotic pressure and increases capillary permeability with increased risk of pulmonary edema. Aorto-caval compression must be prevented by using left uterine displacement. The doses of anesthetic drugs must be adjusted. Maternal local anesthesia can be effectively used for most needle-based and single port fetoscopic procedures. When multiple ports or caesarian section could be necessary, regional anesthesia; epidural or combined spinal epidural can be added. On the other hand, fetal anesthesia is indicated only for endoscopic procedures performed directly on the fetus. All fetal anesthetic drugs are typically administered through intramuscular route and consists of opiates and non-depolarizing muscle relaxants. Atropine is usually given to avoid fetal bradycardia. For placental or cord procedures with no direct fetal contact, the risk–benefit of fetal anesthesia should be weighed [32–35].
