Skip to Main Content

++

See also Chapter 180.

++

  • Airway and airway equipment:
    • Mallampati classification may underestimate difficulty of intubation
    • Evaluate carefully neck mobility (presence of “buffalo hump” posteriorly)
    • Look at the patient supine as well as sitting (enlarged breasts, position of neck)
    • Have extra equipment (airway cart) immediately available when planning general anesthesia for a pregnant patient
    • Difficult intubation is more likely (risk increased about 4-fold)
    • Enlargement of lingual tonsils (protrusion of tongue) is an important reason for Mallampati 3–4 scores: this results in reduced orohypopharyngeal junction diameter
    • Increased risk of injury resulting in swelling and bleeding during laryngoscopy
    • When difficulty in intubation is anticipated, the route of choice for fiber-optic intubation is “oral” rather than nasal
  • NPO guidelines:
    • Fasting time for pregnant patients before elective cases is the same as that for the nonpregnant population
  • When is a pregnant patient considered to have a full stomach?
    • Presence of heartburn is suggested to be indicative of reduced lower esophageal sphincter (LES) tone (<20 cm H2O) and potential regurgitation during induction and mask ventilation
    • Early onset heartburn is hormonally driven
    • From about 20 weeks the enlarging uterus mechanically distorts the position of the stomach and the LES and increases intra-abdominal pressure
    • Gastric emptying is “not” reduced in pregnancy until advanced stages of labor
  • Looking after the fetus (see detailed discussion about fetal well-being and anesthesia):
    • Every pregnant patient should have an identified designated obstetrician with hospital privileges available before any elective surgery; in an emergency, attempts should be made to contact the on-call obstetrician
  • Laboratory tests:
    • Routine laboratory tests are similar to those for the nonpregnant female: CBC to evaluate for presence of anemia. All other tests should be performed as clinically indicated
    • Ketosis and hypoglycemia are common in pregnant patients when NPO for a prolonged period of time. This is well tolerated and routine testing is not recommended
    • Type and screen should be done for all cases in case labor ensues; extent of maternal hemorrhage is unpredictable
  • Postoperative planning:
    • Patients who are <24 weeks pregnant are recovered in the general PACU and are discharged to the general floor (fetus is not considered viable)
    • Patients who are >24 weeks pregnant are recovered and are transported to labor and delivery once stable postoperatively (monitoring, staff, and neonatology is immediately available should labor ensue)
    • ICU admission criteria are similar to those for nonpregnant patients; obstetrical input into ICU care should be arranged

++

  • Effect of maternal surgery on the offspring with emphasis on teratogenicity of anesthetic agents:
    • No anesthetic drug has been shown to be clearly dangerous to the human fetus
    • Incidence of stillbirth and birth defects is unchanged
    • Incidence of low birth weight is increased
    • Incidence of neural tube defects increased if surgery is in the first trimester
    • Although some agents (N2O, benzodiazepines) have been implicated in adverse neonatal outcome, these studies have been either refuted or associated with exposure in excess of an average anesthetic
    • There is no optimal anesthetic technique
    • Avoid elective surgery in the first trimester
    • Enhanced risk of preterm labor after abdominal and pelvic surgeries, especially in cases of acute ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.