Anaesthetic considerations for non-obstetric surgery during pregnancy
Department of Anesthesiology, Columbia University, New York, NY 10032, USA. BJA British Journal of Anaesthesia
(Impact Factor: 4.85).
12/2011; 107 Suppl 1(Suppl 1):i72-8. DOI: 10.1093/bja/aer343
Surgery during pregnancy is complicated by the need to balance the requirements of two patients. Under usual circumstances, surgery is only conducted during pregnancy when it is absolutely necessary for the wellbeing of the mother, fetus, or both. Even so, the outcome is generally favourable for both the mother and the fetus. All general anaesthetic drugs cross the placenta and there is no optimal general anaesthetic technique. Neither is there convincing evidence that any particular anaesthetic drug is toxic in humans. There is weak evidence that nitrous oxide should be avoided in early pregnancy due to a potential association with pregnancy loss with high exposure. There is evidence in animal models that many general anaesthetic techniques cause inappropriate neuronal apoptosis and behavioural deficits in later life. It is not known whether these considerations affect the human fetus but studies are underway. Given the general considerations of avoiding fetal exposure to unnecessary medication and potential protection of the maternal airway, regional anaesthesia is usually preferred in pregnancy when it is practical for the medical and surgical condition. When surgery is indicated during pregnancy maintenance of maternal oxygenation, perfusion and homeostasis with the least extensive anaesthetic that is practical will assure the best outcome for the fetus.
Available from: Alex Bekker
- "The need for anesthesia and surgery during pregnancy occurs in 0.75% to 2.0% of all pregnancies. Although surgery can be required during any stage of pregnancy depending on the urgency of the procedure (Reitman and Flood, 2011), surgery occurs in 0.2% to 1% of all parturients during the first Neurotoxicology and Teratology 43 (2014) 51–58 Abbreviations: 1HP, offspring of dams prenatally exposed to 1 h infusion of propofol on gestational day 18; 2HP, offspring of dams prenatally exposed to a 2 h infusion of propofol on gestational day 18; G18, gestation day 18; IV, intravenously; N, number of dams or litters ; n, number of offspring or pups; P0, postnatal day 0; Pxx, postnatal day xx. ⁎ Corresponding author at: Department of Anesthesiology, "
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ABSTRACT: Preclinical studies suggest that propofol may cause damage to immature neurons. However, the effect of maternal propofol exposure on the neuronal development of the offspring is largely unknown. In this study, pregnant rats were assigned to receive continuous infusion of saline (control), propofol for 1 h (1HP) or 2 h (2HP) on the gestational day 18. An additional group (Lipid) was assigned to receive continuous infusion of intralipid fat emulsion (vehicle of propofol) for 2 h. Pups were then tested on the appearance and progression of sensory and physical motor abilities between postnatal day 0 (P0) and P28. The brain and body weights of pups from 2HP group on P10 were significantly lower than those of the saline control group, although they were the same in all four groups at birth (P0). Pups from 1HP and 2HP groups, but not Lipid group, showed slower maturation of eyes (delayed opening) and several neurological reflexes (hindlimb reflex, righting reflex); they also showed delayed improvement in execution on gait reflex and inclined board tests. The forelimb reflex and negative geotaxis was also delayed in 2HP group. All parameters examined except body weight of 2HP pups, recovered to normal levels by P28. We conclude that administration of propofol to pregnant rats leads to retardation in physical and neurological reflex development in their offspring.
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