hello !
we received a 32 yr pregnant lady with symptomatic GSD.
SHE IS IN 2ND TM.posted for LAP.Chole.
anesthetic implications of laporscopic surgery in pregnant lady...
plz post ur views.
I PREFER EA+SEDATION OF FENTANYLE+PROPOFOL. MONITORRING FOETAL STATUS NECESSARY&OXYGENATION +LATERAL TILTING OF TABLE.
2nd trimester is the safest period to give anaesthesia
GA/CV is the best & most relaiable option
Goals to include
1.Anti aspiration prophylaxis
2.RSI intubation
3.Tocolytics to avoid premature labour
4.Avoid aortocaval compression with wedge
5.Ensure adequate uteroplacental blood flow by limiting Intra-abdominal pressure and haemodynamics
6.Fetal tococardiographic monitoring
I do not agree with Epidural and IV sedation with fentanyl /propofol in these pateints
reasons being
1.Airway protection under sedation is not assured
2.Ventilatory sufficieny in the presence of hypercarbia and sedation is not assured
3.With sedation risk of aspiration is increased
4.Epidural already produces hypotension, add on propofol and it may lead to significant decrease in uteroplacental blood flow
5.Patient already has decreased DO2 as a result of physiological dilutional anemia. Add hypoventilation due to sedation and hypotension and then you may be in and around critical DO2.
I think we as anesthetists continue to be enamoured with techniques rather than goals.
I can tell for sure that there is no evidence that EA is safer or superior to GA in pregnancy or in lap surgeries.
regs
Hi, with the availbility of good GA medicine and monitoring equipments, GA is much suppirior then EA+sedation in this situation.
regards.