CPM Spring 2019 - 4

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From the Editor

ANESTHESIA CARE FOR
SPECIAL PATIENTS:

Joseph F. Answine, MD, FASA
Central PA Medicine Editor-in-Chief

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Dauphin@pamedsoc.org

Dauphin County Medical Society
777 East Park Drive, PO Box 8820
Harrisburg, PA 17105

Surgery During
Pregnancy

he most important concept to enlargement, and increased vascularity.
understand in this case is that Furthermore, there is an increased risk of
there are two patients, mother and aspiration due to extrinsic compression
fetus. Surgery, however, during of the stomach and increased potential
pregnancy is not uncommon, occurring for regurgitation of stomach contents.
in 1 out of every 50 pregnant women. Therefore, maternal and fetal hypoxemia
Common surgeries are appendectomy, and hypercarbia would likely be avoided
cholecystectomy, trauma surgery and for with local or regional anesthesia.
maternal malignancy.
If the surgery cannot be delayed, then
Any surgical procedure runs the risk of the later in the pregnancy the better such
maternal and fetal morbidity, therefore, as late 2nd or 3rd trimester. The biggest
if the surgery can be delayed until a few risk to the fetus in later stages, as stated
weeks after delivery, that is the best scenario above, is maternal morbidity or mortality.
because the baby will have been born Furthermore, there is a risk of premature
and the mother's physiology will return labor, however, the risk is lower in the
to baseline, including airway anatomy, case of a surgical procedure that is distant
hematology, and intravascular fluid levels. from the gravid uterus which will make
irritation or manipulation of the uterus
Along these lines, any anesthetic should less likely as that could lead to premature
be considered potentially teratogenic, uterine activity. To reduce the risk of fetal
however all commonly used anesthetics harm from premature delivery, waiting
have been used during pregnancy; and at until further along as deemed appropriate
common dosages, none appear to pose a by the obstetricians and neonatologists
significant problem. In the third trimester, would be appropriate.
little harm would come to the fetus with
the exposure required for surgery especially
The usual goals of higher maternal oxygen
for low risk, minimally invasive procedures. content, keeping carbon dioxide levels from
Even nitrous oxide with its effect on DNA being too high or low altering placental
synthesis would likely not have a negative blood flow, and keeping hemodynamics
impact at standard dosages for a short within 20% of baseline values should
period of time.
provide an excellent overall outcome.
With maternal complications commonly
being the biggest risk to the fetus, the least
invasive anesthetic would be the most appropriate, therefore, a local anesthetic or a
regional block would provide the lowest risk.
Why? Because the airway of the pregnant
patient is altered with weight gain, breast

Spring 2019 Central PA Medicine

REFERENCE
Johnson, Trevor, Nejdlova, Martina. Anaesthesia for
non-obstetric procedures during pregnancy. Continuing Education in Anaesthesia Critical Care & Pain.
2012. 203-206.

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CPM Spring 2019

Table of Contents for the Digital Edition of CPM Spring 2019