Anesthetic Risk in the Pregnant Surgical Patient

Pedersen, H.; Finster, Mieczyslaw

doi:10.1097/00006254-198006000-00011

Cited by 15 publications

(19 citation statements)

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“…Regional techniques of anesthesia are therefore recommended in the first trimester, and general anesthesia should be avoided if possible. [6] If an elective procedure is required, it is recommended to temporize and defer intervention until the second trimester, when fetal risks are minimal. [7]…”

Section: Discussionmentioning

confidence: 99%

Challenges on percutaneous nephrolithotomy in pregnancy: Supine position approach through ultrasound guidance

et al. 2013

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Urolithiasis in pregnancy represents a major diagnostic and therapeutic challenge to the obstetrician, urologist, radiologist and anesthetist. It is a cause of major concern, considering the potential adverse effects of radiation exposure and of any invasive surgical procedure and anesthesia on the mother and fetus. Fortunately, with conservative management, 70-80% of symptomatic calculi pass spontaneously with no sequel. However, fever, infection, uncontrolled pain and progressive hydronephrosis are indications for surgical intervention when retrograde placements of a ureteral stent or a percutaneous nephrostomy tube are the most traditional options. The recent technological advances in stone fragmentation devices and the administration of safe anesthesia have forced clinicians to embark on more definitive stone management techniques in pregnancy. Ureteroscopy is considered the first definitive treatment of obstructive ureteral calculi during all trimesters of pregnancy, but also has limitations. Although generally avoided during pregnancy, percutaneous nephrolithotomy can be a good treatment choice in selected patients.

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Section: Discussionmentioning

confidence: 99%

Challenges on percutaneous nephrolithotomy in pregnancy: Supine position approach through ultrasound guidance

et al. 2013

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“…In general, surgery is avoided during pregnancy because of potential compromise to the fetus. The developing fetus may experience teratogenic effects from drugs administered during the course of anesthesia (9–11). Premature labor is often associated with surgery during pregnancy, particularly abdominal procedures (12,13).…”

Section: Cardiac Surgery During Pregnancymentioning

confidence: 99%

Labor analgesia for the parturient with cardiac disease: what does an obstetrician need to know?

Kuczkowski

2004

Acta Obstet Gynecol Scand

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Maternal heart disease complicates 0.2-3% of pregnancies. The optimal management of the pregnant patient with cardiac disease depends on the cooperative efforts of the obstetrician, the cardiologist and the anesthesiologist involved in peripartum care. A comprehensive understanding of physiology of pregnancy and pathophysiology of underlying cardiac disease is of primary importance in provision of obstetric analgesia or anesthesia for this high-risk group of patients. This article will review the current guidelines and standards pertinent to management of obstetric analgesia and anesthesia in parturients with cardiac disease.

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“…The use of general anesthesia does not place the fetus at increased risk, and there should not be any increase in maternal morbidity (Pedersen and Finster 1979;Brodsky et al 1980). The use of general anesthesia does not place the fetus at increased risk, and there should not be any increase in maternal morbidity (Pedersen and Finster 1979;Brodsky et al 1980).…”

Section: Treatment Harmsmentioning

confidence: 99%

Cancer in pregnancy: maternal-fetal conflict

Oduncu

Kimmig

Hepp

et al. 2003

J Cancer Res Clin Oncol

103

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The occurrence of malignancies during pregnancy has increased over the last decades. They complicate approximately 1 per 1000 pregnancies. The most common malignancies associated with pregnancy include malignant melanoma, malignant lymphomas and leukemia, and cancer of the cervix, breast, ovary, colon and thyroid. Since it is impossible for prospective randomized clinical trials to be conducted in this field, relevant data have been generated from case reports and matched historical cohort studies in order to evaluate the treatment outcomes and the issues complicating the management of malignancy in the pregnant patient. There is almost always a conflict between optimal maternal therapy and fetal well-being. The maternal interest is for an immediate treatment of the recently diagnosed tumor. However, the optimal therapy, be it chemotherapy, radiotherapy or surgery, may impose great risks on the fetus. Consequently, either maternal or fetal health, or both, will be compromised. Therefore, both the pregnant patient and her physician are often in a dilemma as to the optimal course. On the basis of the medical facts, we discuss the issues raising potential ethical conflicts and present a practical ethical approach which may help to increase clarity in maternal-fetal conflicts. We review the available data informing the incidence and impact of the most common malignancies during pregnancy and their treatment on both the pregnant woman and her fetus. The optimal therapy for the tragic diagnosis of cancer in pregnancy requires a collaborative and interdisciplinary approach between gynecologists, oncologists, obstetricians, surgeons, neonatologists, psychologists, nursing staff and other disciplines. The purpose of this article is not to answer specific questions or to construct management schemes for specific tumors but to provide a framework for approaching some of these complex issues.Keywords Cancer in pregnancy AE Maternal-fetal conflict AE Patient autonomy AE Maternal beneficence AE Fetal beneficence Conflicts raised by issues complicating the management of ''cancer in pregnancy'' Any choice of the best possible treatment option for pregnant women with cancer has to be based on precise medical facts. However, there are-arising from the special constellation of concomitant cancer and pregnancy-a number of issues seriously complicating the management of malignancy in the pregnant patient. Severe conflicts arise concerning the health and life of the mother and fetus by the diagnosed tumor and its therapy. One major conflict is the question: Should the therapy of choice be different in the presence of a pregnancy? The presence of a pregnancy aggravates the situation for the physician and the patient because the decision made needs to take into account the interests of the mother and the fetus. Possible conflicts are raised by different issues which complicate the management of cancer in the pregnant woman in a distinctive manner different to tumor therapy outside pregnancy. The complicating issues relate to (1) medical...

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Anesthetic Risk in the Pregnant Surgical Patient

Cited by 15 publications

References 0 publications

Challenges on percutaneous nephrolithotomy in pregnancy: Supine position approach through ultrasound guidance

Challenges on percutaneous nephrolithotomy in pregnancy: Supine position approach through ultrasound guidance

Labor analgesia for the parturient with cardiac disease: what does an obstetrician need to know?

Cancer in pregnancy: maternal-fetal conflict

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