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ANESTHESIA ALERT
Paloma Toledo, MD, MPH
Anesthesia for the Pregnant Patient
Tips for when expectant mothers undergo non-obstetric surgery.
hen a pregnant patient needs surgery that's unrelated to her pregnancy, understanding and managing the unique risks to both the mother and
the unborn child are critical, even in the very
early stages of pregnancy.
W
Mother and child
Every year, about 80,000 pregnant women in
the United States — that's about 1 in 50 —
require non-obstetric surgeries during pregGROWING CONCERN Ongoing
nancy, with many taking place in outpatient
physiologic changes throughout
settings. No currently used anesthetic agents pregnancy produce a wide variety of
unique challenges.
have been linked to any teratogenic effects in
humans when used at standard concentrations, according to the
American Society of Anesthesiologists' statement on non-obstetric
surgery during pregnancy, but you should take several other factors
into consideration.
• Respiratory system. Numerous physiologic changes in the airways of
pregnant women underscore how important adequate pre-oxygenation is and how important it is to closely monitor oxygen levels during
surgery.
As pregnancies progress and women gain weight, capillaries become
engorged, leading to upper airway edema and decreased internal tracheal
diameter. One result is that intubation failure rates for pregnant patients
(1:280) are 8 times higher than those for non-pregnant patients (1:2,240).
It's important to choose an appropriately sized endotracheal tube.
Pregnant patients also have decreased functional residual capacity,
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U LY 2013