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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
