This review describes the general anaesthetic principles, concerns regarding anaesthetic drugs and outlines some specific conditions of non-obstetric surgeries. Abdominal pain is the most common presenting symptom, and the consideration of multiple pathologic disorders should be entertained.
When considering the possible teratogenicity of various anaesthetic agents, several important points must be kept in mind. General anaesthetic drugs inhibit synaptic transmission and may lead to abnormal synaptic connections and inappropriate apoptosis.
Tocolytic therapy If premature labour occurs, tocolysis will be necessary to preserve the pregnancy. However, 7 days postdischarge, she presented to labor and delivery with premature labor and spontaneous vaginal delivery of a nonviable fetus.
In a new window Figure 1. Currently, surgical mortality is not significantly greater in women who are pregnant compared to those that are not. Complete blood count, complete metabolic profile, urinalysis, and urine culture were sent to the lab. Later that day, the patient called the office for increasing abdominal pain.
A total of five studies have attempted to understand the complex relationship between surgery and anesthesia and pregnancy [Smith BE. The teratogen must be given in a sufficient dose for a substantial period of time at a critical developmental point to produce the defect.
However, urgent surgery should not be delayed as secondary complications may increase the risk to both mother and fetus.
Hemodynamics Fetal Hypoxia and Acidosis Maintain uterine oxygenation by avoiding hypotension left side positioning and maintaining oxygenation. Obesity and oedema can obscure anatomical landmarks. The decision on proceeding with surgery should be made by multidisciplinary team involving anaesthesiologists, obstetricians, surgeons and perinatologists.
All volatile agents up to an MAC of 1. Physiological changes mask the early signs of blood loss and subclinical hypovolaemia will compromise placental perfusion. Volatile agents do not compromise uterine blood flow as long as blood pressure is maintained [Stoelting RK.
The use of volatile anaesthetic agents has been advocated as they relax the uterus, although high concentrations can cause undesirable hypotension. Resuscitation, if required, should be vigorously performed following the standard advanced life support or advanced trauma life support protocols, with the addition of left lateral tilt to avoid supine hypotension.
Sonogram indicated gestational age at 20 weeks, 6 days consistent with last menstrual period, adequate fetal heart tones, and equivocal for acute appendicitis. Routine pregnancy testing should be mandatory for all women of child-bearing age. Labs revealed white blood count of Pelvic examination was normal.
A smaller tracheal tube may be required. Maternal hypercapnia, which may occur during spontaneous ventilation and deep levels of anaesthesia, causes fetal respiratory acidosis, uterine vasoconstriction, and reduced uterine blood flow. Nonetheless, delicate associations cannot be ruled out.
As changes in maternal position can have profound haemodynamic effects, positioning during anaesthesia should be carried out slowly.underwent non-obstetric surgical intervention in the ﬁrst trimester was %. Sub-analysis of papers reporting on appendectomy during pregnancy revealed a high rate (%) of surgery-induced labor.
Fetal loss associated with appendectomy was %; however, this rate was increased when peritonitis was present (%).
Download Citation on ResearchGate | Fetal Risk of Anesthesia and Surgery during Pregnancy | In an attempt to define the risk to the fetus associated with anesthesia and surgery during pregnancy, a study was performed using health insurance data from the province of Manitoba ( to ).
This is a reflective essay based on my personal experience as a student anaesthetic practitioner which happened during in one of my clinical placements in an acute hospital. This is a case of a 42 year old at her 24 weeks gestational pregnancy who underwent an emergency appendicectomy under a general anaesthesia with difficult intubation.
Maternal cardiac output increases in pregnancy by 50% and peaks by the end of the 2nd trimester. This This is due to a combination of an increased heart rate (25%) and stroke volume (30%).
Routine pregnancy testing should be mandatory for all women of child-bearing age. Note that organogenesis occurs from days of gestation. Early concerns for the pregnant patient revolve around the potential for altered organogenesis, but as the fetus matures concerns shift towards fetal hypoxia (as metabolic demands increase) and accidental induction of premature labor.
Up to 2% of pregnant women undergo surgery for non-obstetric conditions each year. 2 The most common indications are acute appendicitis, cholecystitis, trauma, and surgery for maternal malignancies. The main risks of surgery during pregnancy are fetal loss, premature labour, and delivery, which can result from both the disease process itself and the intervention.Download