General and local anesthetics and muscle relaxants

General and regional anesthesia are largely safe in all stages of pregnancy. Although general anesthetic agents can rapidly cross the blood-brain barrier and the placenta, their duration of action is short and the risk of neonatal depression is low after a cesarean section. However, respiratory or circulatory depression arising during a course of maternal anesthesia, stronger uterine contractions, or events such as malignant hyperthermia, can harm the fetus. There is no indication that an uncomplicated general anesthetic can lead to developmental disorders, although in some animal experiments neurotoxic effects have been observed. Local anesthetics used for epidural or spinal anesthesia in labor appear to have no lasting effect on the neurophysiology of the newborn. Prilocaine should be avoided due to a high risk of methemoglobinemia. Based on current knowledge, none of the usual injection, inhalation or local anesthetics have teratogenic properties.