Perioperative Anesthetic Care for Laparoscopic Appendectomy in a Pregnant Woman: A Case Report

Introduction: Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy and poses significant diagnostic and management challenges. Physiological and anatomical changes during gestation can obscure classical clinical signs, leading to delays in diagnosis and increased risk of maternal and fetal morbidity. Prompt surgical intervention is essential, and laparoscopy has become increasingly favored for its benefits in postoperative recovery and complication reduction. Anesthetic care in this population must account for altered maternal physiology, fetal safety, and perioperative risks. Case Presentation: We report a case of a 31-year-old woman at 18 weeks of gestation who presented with right lower quadrant abdominal pain, nausea, and vomiting. Physical examination revealed localized tenderness and rebound pain, with a total Alvarado score of 8. Laboratory findings showed leukocytosis. Obstetric ultrasound confirmed a viable intrauterine pregnancy. Abdominal ultrasound demonstrated an enlarged non-compressible tubular structure suggestive of appendicitis. The patient underwent emergency laparoscopic appendectomy under general anesthesia using propofol, fentanyl, rocuronium, and sevoflurane, with intra-abdominal pressure maintained below 12 mmHg and left uterine displacement applied. Intraoperative fluid management included gelafusal, Ringer lactate, and normal saline. Multimodal analgesia was administered, and fetal heart tones remained reassuring throughout. Postoperative recovery was uneventful, and the patient was discharged on postoperative day four. Discussion: This case illustrates the complexity of managing non-obstetric surgical emergencies during pregnancy. The choice of laparoscopic approach in the second trimester is supported by growing evidence indicating safety when physiologic parameters are maintained. Anesthetic management requires in-depth understanding of pregnancy physiology to avoid maternal hypoxemia, aspiration, and uteroplacental hypoperfusion. Fluid therapy must be balanced to support maternal hemodynamics while avoiding overload. Multimodal analgesia plays a critical role in minimizing opioid exposure and ensuring early recovery. Conclusion: Emergency laparoscopic appendectomy in pregnancy can be performed safely with individualized anesthetic management and multidisciplinary coordination. The principles of maternal-fetal physiology should guide perioperative decisions to optimize outcomes. Keywords: Pregnancy, Appendicitis, Laparoscopic Appendectomy, Anesthesia, Perioperative Care, Maternal-Fetal Safety