This document discusses anesthesia considerations for non-obstetric surgery during pregnancy. It covers topics such as placental transfer of anesthetic drugs, teratogenic risks, and techniques to ensure maternal and fetal safety. Regional anesthesia is preferred when possible to minimize drug exposure. General anesthesia requires careful maintenance of oxygenation, ventilation, hydration and avoiding hypotension. Fetal monitoring may be needed depending on gestational age. Postoperative monitoring and analgesia techniques aim to prevent preterm labor. Overall the goals are maternal safety, maintaining the pregnancy, and achieving the best fetal outcome.

1. Anesthesia in pregnancy
for
non obstetric surgery
Dr.
N.Agrawal

4. Ground
APPLIED PHYSIOLOGY

7. Level One
UTEROPLACRNTAL BLOOD SUPPLY

8. Second level
REGIONAL ANESTHESIA-----
Spinal
Epidural
CSE
TAB

9. Level three
O GENERAL ANESTHEISA

10. Level four
O Painless labour

11. Level Five
O MEDICAL DISEASES COMPLICATING
PREGNANCY

12. Level six
O ECLEMPSIA

13. Level seven
O ANSTHSIA IN PREGNANCY FOR NON
OBSTRETIC SURGERY

14. Level eight
O Anesthesia for foetal surgery

15. GOALS
O Maternal safety
O Maintain pregnancy
O Best foetal outcome
O Inhibit uterine contractions
O Prevent Preterm labor or delivery

16. Procedures
O Cervical encirclage
O Appendicitis
O Ovarian tumor
O Trauma
O Neurosurgery

17. Incidence
O 1-2 %
O 42%, 35%, 23% (first, second, and third)

18. Maternal safety
O American college of obstetrician and
Gynecologist says pregnant woman
should never denied surgery or
anesthesia irrespective of term

19. RSI
O Give cricoid pressure
O Pre oxygenate for 5 min
O If intubation fails use LMA
O Use adequate depth of anesthesia
O IPPV
O Normocarbia , normovolumia

20. Foetal safety
O Minimize dose
O Timing of exposure
O Until now no anesthetic drug is clearly
proven to be hazardous to foetal
O Lipid solubility allows rapid transfer
O Protein solubility variable effect

21. Placental transfer
O Type I : complete transfer with equal
equilibrium e.g. THIOPENTONE

22. O Type II : higher concentration in foetal
e.g. KETAMINE

23. O Type III : minimum amount reaches
e.g. SUCCINYLCHOLINE

24. MECHANISM OF TRANSFER
O Simple diffusion
e.g. paracetamol , midazolam
O Facilitated diffusion
e.g.
glucocorticoids,cephalosporine
O Active transport
e. g. dopamine, norepinephriene
O Pinocytosis

25. Issue of Teratogenicity
O It is defined as a substance that causes
particular defect in foetus

26. O Hypoxia,
O hypotension,
O hypercarbia and
O stress may lead to teratogenic effect

27. O Malformation occurs if exposure is
between 2wk to 8 wk

28. Pregnancy risk categories
O Label to include warning of risk of drug
during pregnancy and lactation
O No NSAID 3rd trimester ,
- it may lead to premature closure of PDA

29. Teratoginicity of Anesthetic
O N2O inhibits methionine synthesis
enzyme necessary for DNA
O May use in low concentration

30. O General anesthetic inhibits synaptic
transmission and may lead to abnormal
synaptic connection
O There is no evidence with volatile
anesthetic agents ,
-to be used in low concentration

31. O Benzodiazepine associated with cleft
palate and cardiac abnormality
O It is recommended to avoid or use
minimum dose, as anxiolytics are must

32. O Barbiturates , propofol , muscle relaxant,
and local anesthetics are safe to use

33. O As auto regulation is absent utero
placental blood flow
O Maintain hydration
O Ephedrine and phenylephrine are safe

34. O Prolonged hypoxia may lead to
vasoconstriction
O May leads to reduced perfusion
hypoxia , acidosis and death

35. O There may be risk of spontaneous
abortion , pre term labour or delivery
O May be due to manipulations during
surgery
O Tocolytic agents to be used , particularly in
third trimester

36. Plan of anesthesia
O Aspiration prophylaxis

37. O Antibiotic

38. O Prophylaxis glucocorticoid: 24-48 hr

39. O Tocolytics

40. Conduct of anesthesia
O Pregnant patient beyond 18-20 wks
Left lateral
O Avoid hypotension
O Regional is preferred take care of
sensitivity

41. O Thiopentone in late pregnancy has no
significant side effect

42. O Ketamine may cause uterine contractions
in early pregnancy
O In late it is safe

43. O Volatile agents inhibit uterine contraction
hence beneficial

44. Foetal monitoring
O 18-22 wk
O After 25 wk

45. Uterine monitoring
O Tocodynameter

46. RECOVERY
O Post operative monitoring

47. Post op analgesia
O Regional nerve block
O Epidural
O PCM
O Avoid NSAID
O Narcotics may cause hypoventilation
show to be used with caution

48. Post partum
O Delay elective surgery for 6wks