Anaesthesia In Pregnancy For Non-obstetric Surgery

Abstract

Non-obstetric surgery during pregnancy is not uncommon and anaesthetists should be aware of the implications for management. The physiological changes of pregnancy need to be considered, especially the avoidance of aortocaval compression, antacid prophylaxis and adequate preoxygenation. The airway needs careful evaluation preoperatively.

The main risk to the foetus is asphyxia. This can be avoided by ensuring adequate maternal oxygenation and ventilation, avoiding hypotension and avoiding drugs that increase uterine tone. This should ensure adequate uteroplacental perfusion. Perioperative foetal heart rate monitoring may be useful if trained staff are available and it is practically possible. Regional anaesthesia is likely to have benefits over general anaesthesia. Attention should be paid to thromboprophylaxis, analgesia and signs of preterm labour in the postoperative period.

When caring for pregnant ladies undergoing non-obstetric surgery a multidisciplinary team is essential. This should include surgeons, anaesthetists, obstetricians, midwives, nurses and neonatologists where available. Elective surgery should be postponed until 6 weeks postpartum when possible. Nonelective surgery should be delayed until the 2nd trimester when organogenesis has occurred and the risk of teratogenicity decreases but this may not always be possible.