Archive July 2013 XIV, No. 7

Anesthesia Alert: Anesthesia for the Pregnant Patient

Tips for when expectant mothers undergo non-obstetric surgery.

Paloma Toledo, MD, MPH

BIO

pregnancy and anesthesia GROWING CONCERN Ongoing physiologic changes throughout pregnancy produce a wide variety of unique challenges.

When 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.

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 pregnancy, with many taking place in outpatient settings. No currently used anesthetic agents 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, which increases the risk of desaturation. Though they consume more oxygen, their PaO2 levels stay largely unchanged. However, due to an increase in alveolar ventilation, they have an uncompensated respiratory alkalosis, with PaCO2 values ranging between 28 and 32mmHg. This relative hypocapnea is important to maintain during surgery, especially laparoscopic procedures, because maternal hypercapnea can result in fetal acidosis.

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