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Title: anesthesia in pregnant lady
Post by: drbikramkb on March 22, 2009, 02:55:25 PM

what will be ur line of m/t for a pregnant lady in first trimester presenting for emergency surgery? what are ur choice of drugs and their effect on the developing fetus?

Title: Re: anesthesia in pregnant lady
Post by: jafo1964 on March 24, 2009, 01:57:08 PM

You would find that answer in any standard anaesthesia text book
The key points are
1. Risk of Aspiration - prevent it
2. Avoid Aorto-caval compression. - wedge
3. Prevent decrease in utero-placental blood flow - maintain MAP
4. Monitor fetal tococardiography
5. Prevent premature labour , fetal death - tocolysis, Avoid N2O
6. AVOID TERATOGENIC AGENTS.

You have not stated the kind and site of surgery.
If CNB is possible that is the best choice. You could choose SAB or Continuous epidural or any other regional procedure as appropriate.

If GA is needed for surgery then go with full fledged GA including RSI and Prokineitcs, H2 antagonists and all the protocol that goes with GA for LSCS.
Ritodrine, terbutaline have been used as tocolytics

Dont forget to get a Obgyn consult before and after surgery

Quite a few anaes drugs need to be avoided - N2O, Benzodiazepines

Inhalationals, IV anesthetics, Muscle relaxants and Narcotics are all safe

regs

Title: Re: anesthesia in pregnant lady
Post by: drbikramkb on March 26, 2009, 03:46:09 PM

thanks ..
is propofol controversy still exists for pregnant pt?is it safe to use in the first trimester of pregnancy?can the standard anesthesia practice for GA induce premature labour?

Title: Re: anesthesia in pregnant lady
Post by: jafo1964 on March 29, 2009, 05:25:05 PM

Propofol is non-teratogenic
Although safely used in Obstetric Anaesthesia, the product insert says that enough studies are not available for recommending its use. So use at your own caution.

Propofol is not approved for RSI also. It can cause more hypotension than Thio in a rapidly administered large dose scenario.
Also there is work that seems to suggest that the peak effect of Thiopentone is better matched to the peak effect of Suxamethonium. I dont remember if propofol peaks earlier or a wee bit later. Will post about it after rechecking the original article.

Yes. standard GA can increase the risk of both premature labour and IUD. So need to monitor fetal wellbeing and also use tocolytics as necessary. Avoid N2O if possible

regs

Title: Re: anesthesia in pregnant lady
Post by: drbikramkb on March 30, 2009, 03:56:17 PM

thanks alot.
regards.

Title: Re: anesthesia in pregnant lady
Post by: yogenbhatt1 on March 31, 2009, 03:10:19 AM

I have been reading all ur points in this chapter.
Do make comments on Anaesthesia for Tightening of Internal Os.
This is a fairly routine surgery and performed around 20 weeks of gestation. Any special precaution you like to mention?

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Anesthesia Discussion => Ask an Expert - Case Studies => Topic started by: drbikramkb on March 22, 2009, 02:55:25 PM