Anesthesia in pregnancy for non-obstetric surgery [gasexchange.com]
Anesthesia during pregnancy: risks of complications
Every mother-to-be strives to ensure that her pregnancy goes smoothly. Unfortunately, due to various external and internal factors, pathologies arise. Sometimes an emergency situation requires the use of anesthesia, which increases the negative risks. Anesthesia is required during dental treatment, during surgical intervention, which must be carried out immediately.
How safe is anesthesia for an unborn child? For how long is it at increased risk? What drugs are used for this?
When pain relief is needed ?
Local or general anesthesia during pregnancy is used in extreme cases. Doctors, as far as possible, refrain from any medications and anesthetics are no exception.
If it is possible to postpone the operation indefinitely, then they resort to expectant tactics, that is, they wait for the baby to be born.
The following situations are exceptions:
- Isthmico-cervical insufficiency, when it is required to place retaining sutures on the cervix;
- Emergency surgical intervention in the event of a threat to the life of a pregnant woman. Usually these are operations to remove appendicitis, gallbladder, ovarian cysts, breast tumors;
- Dental treatment during pregnancy, when anesthesia is necessary to eliminate pulpitis, when a tooth is pulled out, etc.
The frequency of use of anesthetics is only 1-2% of all pregnancies.
Potential risks associated with the use of anesthetics
Means of this group, like other medications, can negatively affect the course of pregnancy. At the same time, the danger exists for all its periods.
This is due to several factors:
- The likelihood of increased uterine tone is high. Contractions of an organ not within the prescribed period lead to premature birth or miscarriage;
- Asphyxiation and fetal death as a result of hypoxia in a woman is likely, which, in turn, may occur during anesthesia;
- Possible teratogenicity - the drugs used can lead to dysfunction of the child's body in the womb and severe deformities.
Experts consider the period from 2 to 8 weeks pregnant to be the most dangerousawn. It is at this time that all organs and systems of the unborn baby are laid and formed. No less high risks in the last trimester. This time is characterized by a high physiological load on the female body, in addition, the likelihood of premature delivery is high.
If possible, doctors postpone surgical procedures until the second trimester (from 14 to 28 weeks) or wait for the woman to give birth. The middle of pregnancy was not chosen by chance - all organs and systems are already fully formed in the baby, and the uterus practically does not react to external influences.
If we turn to the statistics, then it claims that, in general, anesthesia during pregnancy at any time is not associated with great risks. For example, female mortality does not exceed that of non-pregnant women. There is a 6% chance of fetal death with interventions in the 2nd and 3rd trimesters, 11% - for up to 8 weeks.
The likelihood of premature birth does not exceed 8%. The incidence of developmental abnormalities in a child with a single use of anesthetics is equal to that of those who have not undergone such manipulations.
It should be noted that doctors in each specific case choose the optimal tactics of pain relief. The anesthesiologist and surgeon, if necessary, assess the complexity of the event, as well as individual factors. The main task of doctors is to maintain pregnancy.
Treatment at the dentist
When to visit the dentist:
- Caries treatment operations;
- Periodontal surgery;
- Installing a bracket system;
- Elimination of inflammation in the oral cavity;
- Tooth extraction.
Prosthetics, implantology and dental calculus removal are best postponed for a while. If necessary, these procedures can be performed in the postpartum period, as they are not considered urgent.
What drugs and types of pain relief is used by modern medicine
Studies have shown that the vast majority of funds have a high level of safety for both the expectant mother and her child.
In addition, according to the doctors themselves, it is not the drug itself that plays a big role in the development of abnormalities, but the technique of the procedure for anesthesia. For example, at the initial stage, one of the most important points is to prevent a sharp drop in blood pressure and oxygen levels in a woman's blood.
As for the funds themselves, their range is now quite wide. For example, Promedol, Morphine, Glycopyrolate, introduced in minimal doses, have no effect on the health of the mother and child.
In combination with other agents and in a small amount, Ketamine is administered, which, with prolonged use, provokes an increase in the tone of the uterus. In the case of local anesthesia, lidocaine is appropriate. It crosses the placenta, but withdrawal quickly enoughfrom the child's body.
Diazepam and nitrous oxide are used very rarely, but nevertheless. It is known that they negatively affect the baby, especially at the initial stage - in the first trimester. According to some experts, a number of topical pain relievers containing adrenaline are also not recommended for pregnant women.
Anesthesia in dentistry during pregnancy involves the use of just such drugs, for example, ultracaine, which is widely used in the field of dentistry, belongs to those. Such substances increase the risk of a sharp narrowing of blood vessels, which leads to a violation of blood supply to the placenta.
Local and epidural (regional) anesthesia is recognized as the safest in medicine. However, there are times when their use is impossible, for example, in the presence of contraindications, as well as in difficult surgical situations. Then they use multicomponent anesthesia with artificial ventilation.
After such an operation, there is a need for tocolytic therapy, the main purpose of which is to reduce the tone of the uterus, to prevent spontaneous miscarriage or premature birth.
Summing up, we can say that any type of pain relief can negatively affect the unborn child, especially the high probability of harm in the first trimester of pregnancy. Therefore, a woman must undergo a thorough examination at the planning stage, and doctors must take all possible measures to eliminate the existing chronic sources of infections.
For example, it is necessary to completely cure carious teeth so that during gestation you do not have to resort to anesthesia to treat the problem.
In the case when a woman is already pregnant and there is a need for surgical intervention, they try to postpone it for a later date - for the second trimester or for the postpartum period. This is possible only if there is no acute pain syndrome and nothing poses a threat to the health of the pregnant woman.
Also, women who decide to become mothers should carefully monitor their condition, adhere to the doctor's guidelines and be careful in everything.