Anesthesia in pregnant patients for nonobstetric surgery

Mhuireachtaigh, Roisin Ní; O’Gorman, David A.

doi:10.1016/j.jclinane.2004.11.009

Cited by 158 publications

(102 citation statements)

References 48 publications

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“…Previous research suggests that 1% to 2 % of women undergo nonobstetric surgery during pregnancy, 2 common operations being appendicectomy, cancer surgery, and orthopedic procedures. Research has also suggested that nonobstetric surgery during pregnancy is associated with adverse birth outcomes: a Canadian study of 2565 pregnant women reported an increased risk of spontaneous abortion after a general anesthetic [relative risk (RR) ¼ 1.58, 95% confidence interval (95% CI) 1.19-2.09]; 3 and a Swedish registry study showed associations between nonobstetric operations during pregnancy and low birth weight.…”

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confidence: 99%

The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy

et al. 2017

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Objective: The aim of this study was to estimate the risk of adverse birth outcomes for women who underwent nonobstetric surgery during pregnancy compared with those who did not. Background: Previous research suggests that nonobstetric surgery occurs during 1% to 2% of pregnancies. However, there is limited evidence quantifying risks to the mother or pregnancy of such surgery. Methods: We examined maternity admissions using hospital administrative data collected between April 1, 2002, and March 31, 2012, and identified pregnancies wherein nonobstetric surgery occurred. We used logistic regression models to determine the adjusted relative risk, attributable risk, and number needed to harm of nonobstetric surgical procedures for adverse birth outcomes. Results: We identified 6,486,280 pregnancies. In 47,628 of these pregnancies, nonobstetric surgery had occurred. We found that nonobstetric surgery during pregnancy was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that every 287 surgical operations were associated with 1 additional stillbirth, every 31 operations associated with 1 additional preterm delivery, every 39 operations associated with 1 additional low birth weight baby, every 25 operations associated with 1 additional caesarean section, and every 50 operations associated with 1 additional long inpatient stay. Conclusions: Although we have no means of disentangling the effect of the surgery from the effect of the underlying condition, we found that the risk associated with nonobstetric surgery was relatively low, confirming that surgical procedures during pregnancy are generally safe. We believe that our findings improve upon previous research, and are useful reference points for any discussion of risk with prospective patients.Keywords: complications, obstetric, pregnancy, safety, surgery (Ann Surg 2017;266:260-266) T raditional teaching states that there is an increased risk of miscarriage, stillbirth, and preterm labor when a pregnant woman undergoes surgery under general anesthesia during pregnancy.1 This risk has however never been quantified and such risks may have decreased with the use of modern anesthetic agents and techniques. At present, when counseling a pregnant woman on this risk, the information provided is not robustly evidence-based.Previous research suggests that 1% to 2 % of women undergo nonobstetric surgery during pregnancy, 2 common operations being appendicectomy, cancer surgery, and orthopedic procedures. Research has also suggested that nonobstetric surgery during pregnancy is associated with adverse birth outcomes: a Canadian study of 2565 pregnant women reported an increased risk of spontaneous abortion after a general anesthetic [relative risk (RR) ¼ 1.58, 95% confidence interval (95% CI) 1.19-2.09];3 and a Swedish registry study showed associations between nonobstetric operations during pregnancy and low birth weight. 4 A systematic review brought these and many smaller studies together.5 In this analy...

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The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy

et al. 2017

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“…4 A decrease in maternal blood flow may cause reduced placental perfusion and fetal hypoxia. 13,14 This situation may result in fetal death. That is why the preferred anesthetic technique during pregnancy should not cause longtime maternal hypotension.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management for Lower Extremity Fractures Surgery in a Patient with Eight Weeks of Gestation: Case Report

Aksoy¹,

Aksoy²,

Dostbil³

et al. 2015

Turkiye Klinikleri J Case Rep

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A pproximately 0.5-2% of all pregnant women undergo non-obstetric surgery during gestation.1 Operations during pregnancy may be related to pregnancy such as cerclage or unrelated to pregnancy such as cholecystectomy or trauma. The type of anesthetic technique is important in all trimesters of pregnancy due to the maternal and neonatal side effects. Especially, the organogenesis period (from 18 to 58 days after conception) has maximum sensitivity to teratogens and anesthetic agents. A AB BS ST TR RA AC CT T Both anesthetic techniques and surgery in the first trimester can adversely affect fetal development during pregnancy and may cause premature birth, fetal abnormalities, spontaneous abortion and lower birth weight. Especially, the organogenesis period (from 18 to 58 days after conception) has maximum sensitivity to teratogens and anesthetic agents. A 26-year-old, previously healthy female was admitted to the Emergency Department with shaft fracture of the left tibia and fibula. Eight weeks of gestation was defined via obstetrics ultrasound. Using combined spinal-epidural anesthesia with 2% lidocaine in a graded fashion provided safe anaesthesia for both the mother and the developing fetus. This case presents the anesthetic approach in a patient with first trimester pregnancy that underwent a surgery due to left tibia and fibula fractures. If non-obstetric surgery is inevitable in the first trimester, the safest anesthesia for both the mother and the baby must be preferred.K Ke ey y W Wo or rd ds s: : Pregnancy; anesthesia; tibial fractures; surgery Ö ÖZ ZE ET T İlk trimesterde yapılan ameliyat ve kullanılan anestezi teknikleri, gebelik süresince fetüsün gelişimini olumsuz etkileyebilir ve erken doğum, fetal anormallikler, spontan abortus ve düşük doğum ağırlığına sebep olabilir. Özellikle, organegenezis dönemi (konsepsiyondan sonraki 18'den 58. güne kadar olan dönem) teratojenlere ve anestezik ajanlara en fazla duyarlılığa sahiptir. Daha önceden sağlıklı olan 26 yaşındaki kadın hasta sol tibia ve fibula kırığı ile Acil Servis'e müracaat etti. Obstetrik ultrason ile 8 haftalık gebelik tespit edildi. Kombine spinal-epidural anestezi kullanılarak %2 lidokain solusyonunun kademeli şekilde uygulanması ile anne ve gelişmekte olan fetüs için gü-venli anestezi sağlandı. Bu vaka raporunda sol tibia ve fibula kırığı sebebi ile ameliyat geçiren ilk trimester gebeliği olan bir hastadaki anestezi yaklaşımı sunulmuştur. Eğer ilk trimesterde cerrahi müdahale kaçınılmaz ise anne ve bebek için en güvenli olan anestezi tercih edilmelidir.A An na ah ht ta ar r K Ke el li im me el le er r: : Gebelik; anestezi; tibia kırıkları; cerrahi T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J C Ca as se e R Re ep p 2 20 01 15 5; ;2 23 3( (4 4)

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“…Most common surgeries during pregnancy are laparoscopic appendectomy (1/1500-2000 pregnancy) and cholecystectomy (1-8/10000 pregnancy). Neurosurgery and cardiovasculer surgery are quite rare in pregnancy (22) . We did not find any reports about the frequency of lomber disc surgery during pregnancy.…”

Section: Dıscussıonmentioning

confidence: 99%

Surgical approach to lumbar disc herniation in pregnant women

Kıbıcı¹,

Kaya²,

Cücü

et al. 2015

sscd

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Objective: Our aim is to emphasize the importance of surgery along with the route of anesthesia and positioning of the patient during surgery when treating pregnant patients who present with progressive neurologic deficit and pain due to lomber disc herniation. Material and Method: Patients in this study were already followed up by our obstetric department. After a conservative medical approach with analgesics, symptoms did not resolve and contrarily worsened progressively so they were referred to neurosurgery department. Three pregnant patients with lomber disc herniation were operated during pregnancy. Two of the three patients presented in their second (n=2) or first trimester (n=1) of their pregnancies. Indications for surgery involved cauda equina syndrome, progressive loss of muscle strength and pain resistant to conservative medical treatment. Two of the three patients presented with primary herniation and the third patient had a recurrent herniation. All of the three patients were requested to sign an informed consent form. Results: Three pregnant patients were operated due to lumbar disc herniation and all the signs and symptoms of herniation resolved soon after surgery. conclusion: Surgical repair of lumbar herniation under spinal anesthesia is safe surgical treatment of choice in pregnant patients which prevents development of permanent neurological deficit and preterm delivery triggered by pain. Key words: Pregnancy, lomber disc herniation, microdiscectomy J Nervous Sys Surgery 2014; 4(3):127-133 Gebelerde Lomber Disk Hernisine Cerrahi YaklaşımAmaç: Gebelerde şiddetli ağrı ve nörolojik defisit nedeniyle cerrahi endikasyonu olan lomber disk hernisi olgularında uygulanacak anesteziyi, hasta pozisyonunu ve cerrahi yöntemin önemini vurgulamak istedik. Gereç ve yöntem: Çalışmadaki olgular kadın-doğum kliniğince takip edilmekteydi. Analjeziklerle ve konservatif tedaviye rağmen, semptomları düzelmeyen veya ilerleyen olgular nöroşirürji kliniğine sevk edildi. Lomber disk hernisi saptanan 3 olgu opere edildi. İki olgumuz, 3. trimesterde, 1 olgumuz ise 1. trimesterdeydi. Ameliyat için kesin endikasyonlarımız, kauda equina sendromu, ilerleyici motor güç kaybı ve konservatif tedaviye yanıt vermeyen ağrıydı. Opere edilen 3 olgumuzdan 2'si primer, 1'i ise nüks olguydu. Tüm olgularımıza spinal anestezi uygulandı. bulgular: Lomber disk hernisi nedeniyle opere edilen 3 olguda da semptom ve bulguların tamamı ameliyat sonrası düzeldi. Sonuç: Gebelerde lomber disk hernisinin spinal anestezi ile ameliyatı güvenli bir yöntemdir. Cerrahi, ağrı nedeniyle erken doğum riskini ortadan kaldırmak ve kalıcı nörolojik defisitleri önlemek için tercih edilecek tedavidir.

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Anesthesia in pregnant patients for nonobstetric surgery

Cited by 158 publications

References 48 publications

The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy

The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy

Anesthetic Management for Lower Extremity Fractures Surgery in a Patient with Eight Weeks of Gestation: Case Report

Surgical approach to lumbar disc herniation in pregnant women

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