Anesthetic considerations in the presence of intrapartum emergencies.

Acute fetal distress requires that the anesthesiologist use his skills and knowledge to achieve a safe anesthetic effect for both mother and infant. Techniques should be individualized in a manner dictated by the situation, and those techniques that least affect the fetus and maternal-fetal interrelationships should be employed. The anesthesiologist must be able to apply regional or general techniques with equal facility and to select agents of the least toxicity and threat to the maternal-fetal relationship. The possibility of perinatal asphyxia is remote when the induction and maintenance of anesthesia are carried out efficiently and carefully. For a fetus that is already stressed, however, injudiciously managed anesthesia can be a serious problem. Finally, because the anesthesiologist administered the anesthetic, he must also be prepared to effectively institute immediate neonatal resuscitative measures in the first five to ten minutes of extrauterine life.