Non-obstetric surgery during pregnancy

hypoxia obstetrics anaesthesia perioperativenursing safety surgery Oct 23, 2023

Your next patient is 26 weeks pregnant and presents for appendicectomy. What do you need to know? 🧐

Your team’s goal is to provide safe anaesthesia for the mother and reduce the risk of fetal harm or pre-term labour. Your priorities depend on the gestation and the surgery. 🤰

There are conflicting opinions about when to use fetal monitoring for non-obstetric surgery, however, in Australia a common approach is to monitor from 24 weeks. Of course, only urgent and necessary surgery is performed during pregnancy where the risk of anaesthesia is lower than the possible impact of the pathology! 🚨🚨

Key points:
👉 Avoid hypoxia, hypotension and hypothermia
👉 Pregnant patients are an aspiration risk after 12 weeks
👉 Oxygen demand is high and oxygen reservoir is low (short safe apnoea time)
👉 Airway is more difficult in third trimester
👉 Left lateral tilt is essential after 18 weeks
👉 Laparoscopic surgery is safe as long as carbon dioxide levels are kept in normal ranges and insufflation pressures are below 15mmHg
👉 Sedation, general anaesthesia and regional anaesthesia can all be performed safely during pregnancy if these basic principles are followed.

Refer to our Concept Series articles on obstetric airway management and GA caesar for me information! 😎

Build knowledge ✅
Improve safety ✅

Ref:
https://www.bjaed.org/article/S2058-5349(20)30143-8/fulltext

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