Effects of TCI Propofol on Maternal and Fetal Outcomes in VP-Shunt Surgery during the First Trimester of Pregnancy: A Narrative Review

Abstract

Neurosurgical procedures during pregnancy, particularly ventriculoperitoneal (VP) shunt placement in the first trimester, pose substantive challenges for anesthetic practice. Drug selection must protect both mother and fetus while accommodating pregnancy-related alterations in pharmacokinetics and pharmacodynamics. Propofol administered via Target Controlled Infusion (TCI) has become a preferred option in neuroanesthesia because it enables rapid reduction in intracranial pressure and precise titration. Reports from neuro-obstetric practice, including VP shunt operations, indicate that TCI propofol maintains stable anesthetic depth with fewer hemodynamic fluctuations than inhalational techniques. In pregnant patients, dosing is individualized using the Marsh model, typically targeting a plasma concentration of 2–4 µg/mL with an induction dose of 1–2 mg/kg. Although propofol readily crosses the placenta, contemporary data show fetal concentrations remain low and are rapidly cleared. Moreover, recent studies have not associated appropriately dosed, closely monitored propofol with increased rates of miscarriage, major congenital anomalies, or reduced live births. Accordingly, for first-trimester neuroanesthesia, TCI propofol is a safe and effective choice that supports maternal cerebral protection while minimizing fetal exposure. When combined with vigilant physiologic monitoring, titration to effect, and adherence to neuro-obstetric best practices, maternal and fetal outcomes are comparable to those achieved with inhalational anesthesia. These findings support the judicious adoption of TCI propofol for VP shunt surgery in early pregnancy, emphasizing individualized dosing and multidisciplinary perioperative coordination to optimize safety and efficacy. This review synthesizes current evidence and offers pragmatic dosing guidance for clinicians, aligned with contemporary neuroanesthesia and obstetric anesthesia standards