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.

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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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