Perioperative Safety in High-Complexity Maternal-Child Anesthesia: Evidence-Based Strategies for Patient Safety
DOI:
https://doi.org/10.51473/rcmos.v1i1.2025.2526Abstract
Introduction: Maternal-child anesthesiology and high-complexity perioperative medicine demand the continuous integration of up-to-date scientific evidence, refined technical skills, and institutional frameworks that sustain safety for vulnerable populations. High-risk pregnant women, neonates, infants, and children undergoing oncological treatment represent groups in which clinical margins are narrow, and the consequences of poor decisions may be irreversible. Objective: To critically review contemporary scientific evidence related to pediatric, neonatal, and obstetric anesthesia and high-complexity perioperative medicine, with emphasis on patient safety, multimodal analgesia, individualized monitoring, perioperative pharmacogenomics, competency-based medical education, and emerging technological perspectives. Methods: Narrative review of the literature, with non-systematic searches in PubMed/MEDLINE, Scopus, Cochrane Library, and SciELO. Indexed articles, reviews, guidelines, consensus statements, and relevant original studies, published preferentially within the last 20 years, were prioritized, including essential classic references, in English and Portuguese. Selection was guided by clinical relevance, level of evidence, and applicability to maternal-child anesthesia and perioperative safety. No formal PRISMA protocol or metaanalysis was conducted. Findings: The reviewed literature supports multimodal analgesia combined with regional blocks, individualized hemodynamic monitoring, protective ventilation, and ERAS protocols as strategies associated with improved care quality and a potential reduction in perioperative complications. In obstetric anesthesia, phenylephrine remains the reference vasopressor, with norepinephrine established as a relevant alternative for its superior preservation of maternal cardiac output. Perioperative management of bleomycin-exposed patients should be individualized, guided by the judicious use of the lowest FiO2 compatible with normoxemia, alongside consideration of additional risk factors. Perioperative pharmacogenomics has clinically identified applications in selected contexts, but does not yet constitute universal screening practice. Competency-based medical education, coupled with qualified preceptorship and realistic simulation, is recognized as a pillar of patient safety in anesthesiology services. Conclusion: Excellence in high-complexity maternal-child anesthesia requires integration of scientific rigor, technical precision, and robust frameworks for medical education and clinical governance. Emerging technological innovations hold genuine transformative potential, provided they are incorporated critically and in an evidence-based manner.
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