Background and Aims The physiological and anatomical changes of the pregnant woman are sometimes challenging for the anesthesiologist1. The goal should be to keep the mother safe while maintaining the pregnant state and minimizing the interference with the fetus1 and the choice of the anaesthetic technique is of the utmost importance.

Methods Description of a case of spinal surgery in a pregnant woman.

Results 35-year-old woman, ASA II, 21 weeks pregnant, scheduled for L5-S1 discectomy due to disabling lumbar pain. Anaesthetic technique was established as general anaesthesia. The induction of anaesthesia was uneventful and accomplished with rapid sequence induction with lidocaine, propofol, rocuronium and remifentanil in perfusion. Intubation was successful at first attempt with videolaryngoscope and ramped position. After intubation the patient was rolled over to the prone position. Sevofluran was used for maintenance of anaesthesia. Analgesia was accomplished with 1g of paracetamol and with administration of ropivacaine and morphine in the epidural space under direct visualization by the surgeon. The patient maintained hemodynamic and ventilatory stability during surgery. Emergence from anaesthesia was uneventful. The patient was taken to the post anaesthesia care unit awake and well. Fetal viability was confirmed with US.

Conclusions Regional anaesthetic techniques during pregnancy are preferred because they minimize fetal drug exposure. Nevertheless, in this case the benefits of general anaesthesia outweighed those of regional one. The length of surgery, the prone position required and the risk of difficult surgical intervention conditioned the choice of anaesthetic technique. However, we minimized fetal exposure to systemic opioids by adopting a multimodal analgesia strategy.