Perioperative Medicine Web-Based Curriculum & Reference

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PERIOPERATIVE MEDICINE

Web-Based Curriculum & Reference

Editors

Kurt J. Pfeifer, MD, FACP

Steven L. Cohn, MD, FACP

Medical College of Wisconsin

State University of New York - Downstate

Pregnancy

Michael P. Carson, MD & David A. Halle, MD

	PREOPERATIVE EVALUATION
	Surgical Risk Factors

	First Trimester
	One study found that anesthesia was associated with fetal neural tube defects and hydrocephalus. [3]

	Second Trimester
	Ideal time to perform indicated procedures but still avoid prolonged surgery.

	Third Trimester
	Surgery may be technically more complicatd by the gravid uterus.
	Regardless of timing of surgery, significant maternal & fetal risks make collaboration between the surgeon, obstetrician, medical consultant and an obstetric anesthesiologist important for determining risk reduction strategies (see table on right).


REGIONAL ANESTHESIA
Can prevent airway compromise - a major source of morbidity to the pregnant patient.
LAPAROSCOPY
Less maternal blood loss and need for analgesics. Decreased risk of preterm labor vs. laparotomy [1] However, limit CO2 insufflation pressure to 12-15mmg Hg to avoid decreasing the pulmonary FRC and cardiac preload [6]
AVOID DELAYING INDICATED SURGERY
Example: gallstone disease associated with pancreatitis. Delaying cholecystectomy associated with multiple return visits to emergency department, longer operative times and hospitalizations, and higher rates of conversion to open laparotomy.