Anaesthesia for Non-Obstetric Surgery During Pregnancy
Highlights
- There is no evidence of teratogenic risk for any currently used anaesthetic agents for non-obstetric surgery at clinical doses and concentrations, even when used in early pregnancy. (View Highlight)
- Historically, the second trimester has been considered the opportune time to perform surgery because the risk of spontaneous abortion is lower than in the first trimester, and the incidence of preterm labour and delivery is lower than in the third trimester. (View Highlight)
- At a minimum, every pregnant patient should have preoperative and postoperative documentation of FHR (View Highlight)
- Currently, sugammadex is not recommended for routine reversal of neuromuscular block in pregnancy, primarily given its potential to encapsulate progesterone and potentially disrupt the integrity of the pregnancy (View Highlight)
- Neostigmine is commonly used for reversal of neuromuscular block during pregnancy. There have been isolated reports of non-consequential fetal bradycardia when neostigmine was given in combination with glycopyrrolate, leading some to suggest atropine (which more readily crosses the placenta than glycopyrrolate) as the anticholinergic agent of choice with neostigmine (View Highlight)
- Inhalational agents are generally preferred for fetal surgeries and may reduce the incidence of uterine contractions and preterm labour in pregnant patients in the late second and third trimesters. All opioids have been used safely, but ketamine should be avoided, as it has been shown to increase uterine tone. (View Highlight)
- Maternal blood pressure decreases during the first trimester, reaching its lowest point near the end of the second trimester before rising again in the third trimester (View Highlight)
- blood flow to the uterus is not autoregulated and is dependent on maternal blood pressure. Although a ‘safe’ lower limit of maternal blood pressure is not known, maintaining a maternal blood pressure at 80–100% of baseline is generally accepted (View Highlight)
- limited doses of NSAIDs can be used to control acute postoperative pain in the second and early third trimesters and do not pose a substantial risk for fetal adverse events (View Highlight)