Outpatient Surgery Magazine

Best Buys - July 2013 - Outpatient Surgery Magazine - Subscribe

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://magazine.outpatientsurgery.net/i/143283

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Page 112 of 116

Page 113 ANESTHESIA ALERT PRACTICAL PEARLS Keep Mother and Baby Safe If you can't delay elective surgery until after pregnancy, here are tips for optimizing maternal and fetal well-being during surgery: Multidisciplinary planning • Arrange for pre- and post-operative fetal heart rate monitoring. • If intraoperative fetal heart rate monitoring is used, arrange for additional personnel and instruments for emergency cesarean delivery. Optimize maternal oxygenation • Ensure adequate pre-oxygenation if general anesthesia is indicated. • Choose an appropriately sized endotracheal tube. • Avoid intraoperative hypoxemia, which can result in fetal hypoxemia. Optimize maternal acid/base status • Avoid intraoperative hypercapnea, which can result in fetal acidosis. • Avoid intraoperative hypocapnea, which can result in decreased uterine blood flow and fetal hypoxemia. Maintain maternal hemodynamics • Maintain left uterine displacement after 18 weeks gestation. • Use increased doses of vasopressor (phenylephrine is preferred) to manage hypotension. • Use antacid prophylaxis after 18 weeks gestation to reduce the risk of aspiration. Avoid teratogens • Avoid hyperthermia, which is a known teratogen. • Shield the abdomen during radiologic procedures. Prevent preterm labor • Prophylactic tocolytics are not indicated pre-operatively. • Avoid dehydration. — Paloma Toledo, MD, MPH

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