Anesthesia Methods in Pregnant Women: A Review Study
,
Abstract
Background: Manage and deal with the pregnant patient undergoing anesthesia for surgical non-obstructed surgery, assess the effects of non-obstetric surgeries on both fetus and mother during pregnancy, and measures to prevent it.
Methods: A review search study was currently managed in PubMed, MEDLINE, Embase, Science gate, Elsevier, Scientific report, Google Scholar, and Cochrane Evidence-Based Medicine Reviews, after obtaining approval from the ethics committee of Tehran University of Medical Sciences. All the reviews identified were restricted to human studies and available in English.
Results: Elective surgery ideally should be avoided during pregnancy while emergency surgery should proceed with consideration for the anesthetic implications of the altered physiology of pregnancy. Caution must be taken during anesthetic application and Airway management.
Conclusion: Pre-oxygenation is essential and consider the rapid-sequence induction accompanied with cricoid pressure to lower the incidence of aspiration. lower MAC values of the volatile anesthetic should be used and medications titrated to preferably produce beneficial effects only.
[1] Heesen M, Klimek M. Nonobstetric anesthesia during pregnancy. Curr Opin Anaesthesiol. 2016; 29(3):297-303.
[2] Ravindra GL, Madamangalam AS, Seetharamaiah S. Anaesthesia for non-obstetric surgery in obstetric patients. Indian J Anaesth. 2018; 62(9):710-716.
[3] Mandim BL. Anesthesia for Non-Obstetrical Surgery during Pregnancy. Gen Med Open Access [Internet]. 2014;03(01):1–4. Available from: http://esciencecentral.org/journals/anesthesia-for-nonobstetrical-surgery-during-pregnancy-2327-5146.1000157.php?aid=37248
[4] Van De Velde M, De Buck F. Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol. 2007; 73(4):235-40.
[5] Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, et al. Chestnut’s Obstetric Principles and Practice Anesthesia. 6th ed. Philadelphia: Elsevier Ltd,Book Aid International; 2020. pp. 13–31.
[6] Pacheco LD, Costantine MM, Hankins GDV. Physiologic Changes During Pregnancy. In: Mattison DR, editor. Elsevier; 2013. pp. 5–16.
[7] Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth. 2011; 107 Suppl 1:i72-8.
[8] Ní Mhuireachtaigh R, O’Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth. 2006; 18(1):60–6.
[9] Gonzalez-Fiol A, Eisenberger A. Anesthesia implications of coagulation and anticoagulation during pregnancy. Semin Perinatol. 2014; 38(6):370–7.
[10] Polifka JE, Habermann J. Anticoagulants, thrombocyte aggregation inhibitors, fibrinolytics and volume replacement agents. In: Christof Schaefer PP and RKM, editor. Drugs During Pregnancy and Lactation. Third Edit. Elsevier; 2015. pp. 225–49.
[11] Stewart MK, Terhune KP. Management of Pregnant Patients Undergoing General Surgical Procedures. Surg Clin North Am. 2015; 95(2):429–42.
[12] Pamela Flood MDR. Anesthesia for Obstetrics. In: Miller’s Anesthesia, 2-Volume Set. 8th ed. Elsevier Inc.; 2016. p. 2328-2358.e6.
[13] Upadhyay S. Perioperative Considerations in Laparoscopic Surgery During Pregnancy. A Mini Review and Updates. EC Anaesth. 2019;5(11):7–15.
[14] Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg. 2005; 190(3):467–73.
[15] Short DJ. Risks associated with anaesthesia and surgery in early pregnancy. RCPCH. 2012; 1–4.
[16] Shergill AK, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker GA, Evans JA, et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012; 76(1):18–24.
[17] Armstrong S, Fernando R. Analgesics and Anti-Inflammatory, General and Local Anesthetics and Muscle Relaxants. In: Clinical Pharmacology During Pregnancy. Elsevier; 2013. pp. 129–44.
[18] Nejdlova M, Johnson T. Anaesthesia for non-obstetric procedures during pregnancy. Contin Educ Anaesth Crit Care Pain. 2012; 12(4):203–6.
[19] D’Angelo R. Anesthesia-related Maternal Mortality. Anesthesiology. 2007; 106(6):1082–4.
[20] Rahman K, Jenkins JG. Failed tracheal intubation in obstetrics: no more frequent but still managed badly. Anaesthesia. 2005; 60(2):168–71.
[21] Kinsella SM, Winton AL, Mushambi MC, Ramaswamy K, Swales H, Quinn AC, et al. Failed tracheal intubation during obstetric general anaesthesia: a literature review. Int J Obstet Anesth. 2015; 24(4):356–74.
[22] Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, et al. Obstetric Anaesthetists’ Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015; 70(11):1286–306.
[23] Maronge L, Bogod D. Complications in obstetric anaesthesia. Anaesthesia. 2018; 73:61–6.
[24] Datta S, Kodali BS, Segal S. Obstetric Anesthesia Handbook. Obstetric Anesthesia Handbook. New York, NY: Springer New York; 2010. pp. 370–383.
[25] Kumar K, Tawfic Q, Armstrong K. Management of Non-Obstetric Pain during Pregnancy: A Review. J Anesth Clin Res. 2020; 11(967):1–5.
[26] Price HR, Collier AC. Analgesics in Pregnancy: An Update on Use, Safety and Pharmacokinetic Changes in Drug Disposition. Curr Pharm Des. 2018; 23(40):6098–114.
[27] Harter K. Opioid use disorder in pregnancy. Ment Heal Clin. 2019; 9(6):359–72.
[28] Lind JN, Interrante JD, Ailes EC, Gilboa SM, Khan S, Frey MT, et al. Maternal Use of Opioids During Pregnancy and Congenital Malformations: A Systematic Review. Pediatrics. 2017; 139(6):e20164131.
[29] ACOG. Opioid Use and Opioid Use Disorder in Pregnancy - ACOG. ACOG Committee Recommendations. 2019; 130(2):81–94.
[30] Källén B, Reis M. Use of tramadol in early pregnancy and congenital malformation risk. Reprod Toxicol. 2015; 58:246-51.
[31] Palanisamy A, Bailey CR. Codeine in mothers and children: where are we now? Anaesthesia. 2014; 69(7):655-60.
[32] Masarwa R, Levine H, Gorelik E, Reif S, Perlman A, Matok I. Prenatal Exposure to Acetaminophen and Risk for Attention Deficit Hyperactivity Disorder and Autistic Spectrum Disorder: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Cohort Studies. Am J Epidemiol. 2018; 187(8):1817–27.
[33] Edwards DRV, Aldridge T, Baird DD, Funk MJ, Savitz DA, Hartmann KE. Periconceptional Over-the-Counter Nonsteroidal Anti-inflammatory Drug Exposure and Risk for Spontaneous Abortion. Obstet Gynecol. 2012; 120(1):113–22.
[34] Li D-K, Ferber JR, Odouli R, Quesenberry C. Use of nonsteroidal antiinflammatory drugs during pregnancy and the risk of miscarriage. Am J Obstet Gynecol. 2018; 219(3):275.e1-275.e8.
[35] Ramoz LL, Patel-Shori NM. Recent Changes in Pregnancy and Lactation Labeling: Retirement of Risk Categories. Pharmacotherapy. 2014; 34(4):389–95.
[36] Arendrup FS, Mazaud-Guittot S, Jégou B, Kristensen DM. EDC IMPACT: Is exposure during pregnancy to acetaminophen/paracetamol disrupting female reproductive development? Endocr Connect. 2018; 7(1):149–58.
[37] Scott-Brown S, Russell R. Video laryngoscopes and the obstetric airway. Int J Obstet Anesth. 2015; 24(2):137–46.
[38] Parangi S, Levine D, Henry A, Isakovich N, Pories S. Surgical gastrointestinal disorders during pregnancy. Am J Surg. 2007; 193(2):223–32.
[39] Alki İ, Kurdo M, Kurdo Z. Nonobstetric surgical intervention in pregnancy. East J Med. 2010; 15:1–6.
[40] Dries DJ. Sabiston Textbook of Surgery. Mattox Ctrdbbmek, editor. Shock. 20th Ed. 2008; 29(5):650.
[41] George PE, Shwaartz C, Divino CM. Laparoscopic surgery in pregnancy. World J Obstet Gynecol. 2016; 5(2):175.
[42] Karaman E, Aras A, Çim N, Kolusarı A, Kızıltan R, Çelik S, et al. Maternal and fetal outcomes after laparoscopic vs. Open appendectomy in pregnant women: data from two tertiary referral centers. Ginekol Pol. 2016; 87(2):98-103.
[43] Soper NJ. SAGES’ guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc. 2011; 25(11):3477–8.
[2] Ravindra GL, Madamangalam AS, Seetharamaiah S. Anaesthesia for non-obstetric surgery in obstetric patients. Indian J Anaesth. 2018; 62(9):710-716.
[3] Mandim BL. Anesthesia for Non-Obstetrical Surgery during Pregnancy. Gen Med Open Access [Internet]. 2014;03(01):1–4. Available from: http://esciencecentral.org/journals/anesthesia-for-nonobstetrical-surgery-during-pregnancy-2327-5146.1000157.php?aid=37248
[4] Van De Velde M, De Buck F. Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol. 2007; 73(4):235-40.
[5] Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, et al. Chestnut’s Obstetric Principles and Practice Anesthesia. 6th ed. Philadelphia: Elsevier Ltd,Book Aid International; 2020. pp. 13–31.
[6] Pacheco LD, Costantine MM, Hankins GDV. Physiologic Changes During Pregnancy. In: Mattison DR, editor. Elsevier; 2013. pp. 5–16.
[7] Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth. 2011; 107 Suppl 1:i72-8.
[8] Ní Mhuireachtaigh R, O’Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth. 2006; 18(1):60–6.
[9] Gonzalez-Fiol A, Eisenberger A. Anesthesia implications of coagulation and anticoagulation during pregnancy. Semin Perinatol. 2014; 38(6):370–7.
[10] Polifka JE, Habermann J. Anticoagulants, thrombocyte aggregation inhibitors, fibrinolytics and volume replacement agents. In: Christof Schaefer PP and RKM, editor. Drugs During Pregnancy and Lactation. Third Edit. Elsevier; 2015. pp. 225–49.
[11] Stewart MK, Terhune KP. Management of Pregnant Patients Undergoing General Surgical Procedures. Surg Clin North Am. 2015; 95(2):429–42.
[12] Pamela Flood MDR. Anesthesia for Obstetrics. In: Miller’s Anesthesia, 2-Volume Set. 8th ed. Elsevier Inc.; 2016. p. 2328-2358.e6.
[13] Upadhyay S. Perioperative Considerations in Laparoscopic Surgery During Pregnancy. A Mini Review and Updates. EC Anaesth. 2019;5(11):7–15.
[14] Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg. 2005; 190(3):467–73.
[15] Short DJ. Risks associated with anaesthesia and surgery in early pregnancy. RCPCH. 2012; 1–4.
[16] Shergill AK, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker GA, Evans JA, et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012; 76(1):18–24.
[17] Armstrong S, Fernando R. Analgesics and Anti-Inflammatory, General and Local Anesthetics and Muscle Relaxants. In: Clinical Pharmacology During Pregnancy. Elsevier; 2013. pp. 129–44.
[18] Nejdlova M, Johnson T. Anaesthesia for non-obstetric procedures during pregnancy. Contin Educ Anaesth Crit Care Pain. 2012; 12(4):203–6.
[19] D’Angelo R. Anesthesia-related Maternal Mortality. Anesthesiology. 2007; 106(6):1082–4.
[20] Rahman K, Jenkins JG. Failed tracheal intubation in obstetrics: no more frequent but still managed badly. Anaesthesia. 2005; 60(2):168–71.
[21] Kinsella SM, Winton AL, Mushambi MC, Ramaswamy K, Swales H, Quinn AC, et al. Failed tracheal intubation during obstetric general anaesthesia: a literature review. Int J Obstet Anesth. 2015; 24(4):356–74.
[22] Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, et al. Obstetric Anaesthetists’ Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015; 70(11):1286–306.
[23] Maronge L, Bogod D. Complications in obstetric anaesthesia. Anaesthesia. 2018; 73:61–6.
[24] Datta S, Kodali BS, Segal S. Obstetric Anesthesia Handbook. Obstetric Anesthesia Handbook. New York, NY: Springer New York; 2010. pp. 370–383.
[25] Kumar K, Tawfic Q, Armstrong K. Management of Non-Obstetric Pain during Pregnancy: A Review. J Anesth Clin Res. 2020; 11(967):1–5.
[26] Price HR, Collier AC. Analgesics in Pregnancy: An Update on Use, Safety and Pharmacokinetic Changes in Drug Disposition. Curr Pharm Des. 2018; 23(40):6098–114.
[27] Harter K. Opioid use disorder in pregnancy. Ment Heal Clin. 2019; 9(6):359–72.
[28] Lind JN, Interrante JD, Ailes EC, Gilboa SM, Khan S, Frey MT, et al. Maternal Use of Opioids During Pregnancy and Congenital Malformations: A Systematic Review. Pediatrics. 2017; 139(6):e20164131.
[29] ACOG. Opioid Use and Opioid Use Disorder in Pregnancy - ACOG. ACOG Committee Recommendations. 2019; 130(2):81–94.
[30] Källén B, Reis M. Use of tramadol in early pregnancy and congenital malformation risk. Reprod Toxicol. 2015; 58:246-51.
[31] Palanisamy A, Bailey CR. Codeine in mothers and children: where are we now? Anaesthesia. 2014; 69(7):655-60.
[32] Masarwa R, Levine H, Gorelik E, Reif S, Perlman A, Matok I. Prenatal Exposure to Acetaminophen and Risk for Attention Deficit Hyperactivity Disorder and Autistic Spectrum Disorder: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Cohort Studies. Am J Epidemiol. 2018; 187(8):1817–27.
[33] Edwards DRV, Aldridge T, Baird DD, Funk MJ, Savitz DA, Hartmann KE. Periconceptional Over-the-Counter Nonsteroidal Anti-inflammatory Drug Exposure and Risk for Spontaneous Abortion. Obstet Gynecol. 2012; 120(1):113–22.
[34] Li D-K, Ferber JR, Odouli R, Quesenberry C. Use of nonsteroidal antiinflammatory drugs during pregnancy and the risk of miscarriage. Am J Obstet Gynecol. 2018; 219(3):275.e1-275.e8.
[35] Ramoz LL, Patel-Shori NM. Recent Changes in Pregnancy and Lactation Labeling: Retirement of Risk Categories. Pharmacotherapy. 2014; 34(4):389–95.
[36] Arendrup FS, Mazaud-Guittot S, Jégou B, Kristensen DM. EDC IMPACT: Is exposure during pregnancy to acetaminophen/paracetamol disrupting female reproductive development? Endocr Connect. 2018; 7(1):149–58.
[37] Scott-Brown S, Russell R. Video laryngoscopes and the obstetric airway. Int J Obstet Anesth. 2015; 24(2):137–46.
[38] Parangi S, Levine D, Henry A, Isakovich N, Pories S. Surgical gastrointestinal disorders during pregnancy. Am J Surg. 2007; 193(2):223–32.
[39] Alki İ, Kurdo M, Kurdo Z. Nonobstetric surgical intervention in pregnancy. East J Med. 2010; 15:1–6.
[40] Dries DJ. Sabiston Textbook of Surgery. Mattox Ctrdbbmek, editor. Shock. 20th Ed. 2008; 29(5):650.
[41] George PE, Shwaartz C, Divino CM. Laparoscopic surgery in pregnancy. World J Obstet Gynecol. 2016; 5(2):175.
[42] Karaman E, Aras A, Çim N, Kolusarı A, Kızıltan R, Çelik S, et al. Maternal and fetal outcomes after laparoscopic vs. Open appendectomy in pregnant women: data from two tertiary referral centers. Ginekol Pol. 2016; 87(2):98-103.
[43] Soper NJ. SAGES’ guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc. 2011; 25(11):3477–8.
| Files | ||
| Issue | Vol 7 No 4 (2021): Autumn |
|
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v7i4.7631 | |
| Keywords | ||
| Physiologic changes of pregnancy Non-obstetric surgery during pregnancy Teratogenicity General anesthesia in pregnancy Airway management Laparoscopic surgery during pregnancy Preterm delivery Fetal asphyxia | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Khan Z, Hameed A. Anesthesia Methods in Pregnant Women: A Review Study. Arch Anesth & Crit Care. 2021;7(4):238-244.
