ABSTRACT
PURPOSE OF REVIEW: Nonobstetric surgery during pregnancy is associated with maternal and fetal risks. Several physiologic changes create unique challenges for anesthesiologists. This review highlights physiologic changes of pregnancy and presents clinical recommendations based on recent literature to guide anesthetic management for the pregnant patient undergoing nonobstetric surgery. RECENT FINDINGS: Nearly every anesthetic technique has been safely used in pregnant patients. Although it is difficult to eliminate confounding factors, exposure to anesthetics could endanger fetal brain development. Perioperative fetal monitoring decisions require an obstetric consult based on anticipated maternal and fetal concerns. Given the limitations of fasting guidelines, bedside gastric ultrasound is useful in assessing aspiration risk in pregnant patients. Although there is concern about appropriateness of sugammadex for neuromuscular blockade reversal due its binding to progesterone, preliminary literature supports its safety. SUMMARY: These recommendations will equip anesthesiologists to provide safe care for the pregnant patient and fetus undergoing nonobstetric surgery.
Subject(s)
Anesthesia , Fetus , Humans , Pregnancy , Female , Anesthesia/methods , Anesthesia/adverse effects , Anesthesia/standards , Fetus/drug effects , Fetus/surgery , Anesthetics/adverse effects , Anesthetics/administration & dosage , Fetal Monitoring/methods , Fetal Monitoring/standards , Pregnancy Complications/prevention & control , Practice Guidelines as Topic , Surgical Procedures, Operative/adverse effects , Anesthesia, Obstetrical/methods , Anesthesia, Obstetrical/adverse effects , Anesthesia, Obstetrical/standardsABSTRACT
Physiologic changes of pregnancy are poorly tolerated in patients with pulmonary arterial hypertension (PAH), and peripartum maternal mortality is high. We present a case of a 31-year-old G3P0020 patient at 35 weeks' gestation with severe World Health Organization group I PAH who underwent cesarean delivery followed by percutaneous right ventricular assist device placement. Risks and benefits of the mode of delivery, neuraxial versus general anesthesia, and mechanical circulatory support are reviewed.
Subject(s)
Heart-Assist Devices , Hypertension, Pulmonary , Pulmonary Arterial Hypertension , Pregnancy , Female , Humans , Adult , Pulmonary Arterial Hypertension/therapy , Cesarean Section , Hypertension, Pulmonary/therapy , Familial Primary Pulmonary HypertensionABSTRACT
Preeclampsia is a severe manifestation of maternal hypertensive disease affecting 2-8% of pregnancies. The disease places women at risk of women at risk of life-threatening events, including cerebral hemorrhage, pulmonary edema, acute kidney injury, hepatic failure or rupture, disseminated intravascular coagulation, eclampsia, and placental abruption. In addition to the maternal disease burden, increased fetal morbidity and mortality occurs due to iatrogenic preterm delivery, fetal growth restriction, and placental abruption. Magnesium therapy for seizure prophylaxis and blood pressure control to limit cardiovascular and cerebrovascular morbidity are the cornerstone of treatment. Interdisciplinary planning and management are crucial to optimizing patient outcomes.
