Anaesthesia for non-obstetric surgery during pregnancy

Question 1

Common non-obstetric surgeries required during pregnancy

Answer 1

• Appendicectomy
• Trauma-related
• Cholecystectomy
• Gynaecological surgery
• Laparotomy for bowel obstruction

Question 2

Risk of miscarriage in patients undergoing non-obstetric surgery during pregnancy

Answer 2

• 3x increased risk
• Highest risk in the 1st trimester

Question 3

Laparoscopic surgery in patients undergoing non-obstetric surgery during pregnancy

Answer 3

• Considered safe in all trimesters of pregnancy
• Pressures should be kept <15mmHg
• Scalpel incision should be performed carefully to prevent accidental uterine puncture

Question 4

Indications for intra-operative foetal monitoring in non-obstetric surgery

Answer 4

• Viable foetus and team ready to perform caesarean section
• Intra-operative foetal monitoring is possible and individual able to interpret results
• Pre-operative consent gained for caesarean

Question 5

At what point (gestation) should a left lateral tilt be put on the bed for pregnant patients

Answer 5

Beyond 18-20 weeks

Question 6

Why is the risk of LA toxicity higher in pregnancy

Answer 6

• Reduced a1-acid protein binding = higher conc of free drug
• Venous engorgement = higher fraction of drug uptake
• Oestrogen and progesterone causing “myocardial irritability”

Question 7

Anaesthetic drugs to avoid in patients undergoing non-obstetric surgery during pregnancy

Answer 7

• Suggamadex is unlicensed for routine use because it encapsulates progesterone and can disrupt pregnancy
• ? use neostigmine and atropine as glyc does not cross the BBB
• Ketamine increases uterine tone