Anesthesia in early pregnancy: all the pros and cons. Anesthesia during pregnancy: possible risks and complications Pregnancy treatment of channels anesthesia consequences

No matter how hard a woman tries to be careful and carefully monitor her health during gestation, it happens that she needs urgent surgical care. Meanwhile, any surgical intervention and the associated use of anesthetics always carries a certain risk for the patient, and during pregnancy, anesthesia becomes doubly dangerous, since in this case the health of not only the mother, but also the unborn child is at risk. What can anesthesia lead to and what methods of anesthesia can be used during this period?

How anesthesia affects pregnancy

Usually, during gestation, doctors try to avoid surgical interventions due to the potential danger from the use of anesthetics. If possible, then surgical operations are postponed until the baby is born.

The use of anesthesia during pregnancy is allowed in the following cases:

Acute dental problems (tooth extraction, pulpitis);
Injuries;
The need for emergency surgery (appendicitis, breast tumor, ovarian cyst);
Exacerbation of chronic diseases.

It is known that any drugs, including anesthetics, can adversely affect the development of the fetus at any time. In particular, anesthesia during pregnancy can cause serious disturbances in the functioning of the body, severe deformities, asphyxia and subsequent death of the child in case of hypoxia in the mother. In addition, the use of drugs in this group in some cases leads to an increase in the tone of the uterus, which threatens with premature birth or miscarriage.

The most dangerous is the use of anesthesia in early pregnancy, between 2 and 10 weeks of gestation. It is during this period that the laying of the organs and systems of the embryo takes place. It is also not recommended to administer anesthetics to pregnant women in the third trimester, as this can provoke a premature onset of labor. Basically, doctors try to carry out any surgical interventions in the second trimester, when the placenta reliably protects the child from any external influences, and there is quite a lot of time left before delivery

How does anesthesia affect pregnancy? Generally speaking, according to statistics, the use of anesthetics when carrying a baby is not associated with great risks:

The frequency of development of congenital pathologies with a single use of anesthesia does not exceed the incidence of such anomalies in pregnant women who have not been subjected to anesthesia;
The probability of fetal death ranges from 6-11%;
The risk of preterm birth due to the use of anesthesia during pregnancy averages no more than 8%;
The rate of maternal mortality during surgery does not differ from similar estimates among non-pregnant women.

However, in the first and third trimester, expectant mothers are usually operated on under general anesthesia for health reasons only. Simple manipulations are performed using local anesthesia during pregnancy. However, recent studies show that most painkillers are completely safe for both the woman and the unborn child. According to experts, the development of abnormalities in the fetus very often does not cause the anesthetic itself. The technique of anesthesia is important: a woman in the position of a sharp decrease in the level of oxygen in the blood and a drop in blood pressure should not be allowed.

Dental anesthesia during pregnancy: what you need to know?

A pregnant woman should pay special attention to the health of the oral cavity, since caries and other diseases of the teeth and gums are a source of constant infection. However, many expectant mothers are sure that dental anesthesia during pregnancy can harm the baby, so they are often afraid to go to the dentist.

Currently, there are many preparations specially designed for pain-free dental procedures. Modern anesthesia used in the treatment of teeth during pregnancy is completely safe for both the expectant mother and the child. To date, for this purpose, medicines are used that do not contain in their composition components that have a vasoconstrictive effect and are able to overcome the placental barrier.

The most effective and completely safe agent for local anesthesia during pregnancy is ultracaine. This drug is quickly excreted from the body, and its use is not capable of harming the health or development of an unborn child. Primacaine is also used to anesthetize teeth during dental procedures. The doctor prescribes the desired dose of the selected drug individually, depending on the duration of pregnancy, age and general health of the patient.

Important information

In conditions requiring surgical intervention for vital reasons, potent drugs can be used for anesthesia during pregnancy: morphine, promedol or ketamine in combination with glycopyrrolate. The safest method of anesthesia for expectant mothers is regional (epidural or spinal) anesthesia.

To inject the anesthetic in this case, a special needle is used, which is inserted into the spinal canal through the intervertebral foramen. The drug enters through the catheter to where the nerve roots that carry pain impulses pass in the spinal cord. If the use of regional anesthesia is not possible, doctors may opt for combined anesthesia with mechanical ventilation. 4.9 out of 5 (25 votes)

There is no doubt: the treatment of pregnant women requires special attention, careful selection of medicines. This is true for surgery, and (doubly!) for anesthesiology. There are no absolutely safe anesthetic drugs, they all have their own toxicity (poisonousness) threshold, which they reach in certain doses. And the anesthesiologist in each case needs to correctly calculate the dose in order to lull the patient, make him insensitive to pain, completely relax all the muscles and even stop his breathing. But all this is only for the duration of the operation itself, after which the person must “wake up”.

Any surgical intervention and associated anesthesia carries a certain risk for any patient. What can we say about a woman carrying a child under her heart! Pregnancy significantly changes the work of almost all major organs and systems of a woman. She begins to breathe differently, her liver, kidneys and heart work in an enhanced mode, the composition of the blood changes, immunity is partially suppressed, the digestive organs are forced to work in a "squeezed" state, etc. And all this changes as the pregnancy itself develops. When choosing anesthesia, the doctor takes into account the permeability of the placenta for anesthetic drugs, the baby's ability to "digest" anesthetic "cocktails" and their effect on the formation of a small organism. All this puts a pregnant woman in a special risk group.

Most often, a pregnant woman ends up on the surgical table due to injuries, acute surgical diseases of the abdominal organs (such as appendicitis), exacerbation of chronic surgical diseases and dental problems.

So, in the first and second trimesters, anesthetic drugs are more dangerous for the child than for the mother, especially in the period between. At this time, the formation of the main organs of the baby takes place, and most anesthetics (painkillers) pass through the placenta, inhibit the growth and development of cells, thereby increasing the risk of deformities (teratogenic effect). In addition to this, due to the operation itself and the action of anesthetic drugs, placental and uterine blood flow is disturbed, and the child's nutrition worsens.

Surgery is not indifferent to the mother. Due to the release of adrenaline and other stress factors, the risk of abortion increases. The mother is more likely to vomit during surgery and get vomit into the lungs (aspiration) with severe pneumonia. Because of all these dangers, in the first and second trimesters, pregnant women are operated on under general anesthesia only for health reasons, that is, in cases where the refusal of the operation directly threatens the life of the mother. Minor operations can be performed under local anesthesia, when an anesthetic is injected directly into the site of the planned surgical intervention (for example, emergency dental procedures). But even so, part of the anesthetic can get to the baby, and maternal pain can increase the tone of the uterus, worsen uteroplacental blood flow and increase the risk.

If necessary and if possible, doctors try to postpone the operation to a later date - (second trimester), since at this time the child's organs are formed, and the excitability of the uterus to external influences is minimal.

In the third trimester, the risk of abortion and life-threatening complications increases even more, the abdominal organs are displaced and "clamped" by the uterus, which also presses on the main blood vessels in the abdomen, disrupting blood flow. Increased pressure in the abdominal cavity is transmitted to the chest cavity, reducing the volume of respiratory movements, and the need for oxygen, on the contrary, increases: the mother also breathes for the child. Therefore, if major surgical interventions are necessary, doctors try to wait until the child's lungs mature. First, a caesarean section is performed in the usual manner, and then the necessary operation.

Pain relief for expectant mothers is the best choice

The safest method of pain relief for mom and baby during pregnancy is considered epidural anesthesia.

For its implementation, a needle is inserted through the holes in the spinal canal directly above the hard shell of the spinal cord, into the epidural space - just where the nerve roots pass, carrying pain impulses from the uterus. To make the procedure painless, before the injection, the skin at the site of the proposed injection is anesthetized. Then a special needle is inserted into which a thin silicone tube (catheter) is inserted; the needle is removed, and the catheter remains in the epidural space - a potent local anesthetic is injected into it. As needed, a medicinal substance can be added through the catheter, prolonging the analgesic effect up to 24-36 hours.

During the procedure, the patient should be in the most bent position: lying on her stomach, bending over, or sitting, bending over.

After the introduction of the drug, anesthesia develops in 10-20 minutes.

At the time of insertion of the catheter, the latter may touch the nerve, causing a short-term shooting sensation in the leg. Another moment that can accompany anesthesia is sometimes a feeling of numbness, weakness and heaviness in the legs.

After this type of anesthesia, the following complications may occur:

Headache appears on the 1-3rd day after anesthesia in approximately 1% of cases. If a headache occurs, anesthesiologists prescribe bed rest, fluids, and pain medications.
At the injection site, there may be pruritus, which can be cured by taking antihistamines under medical supervision.
Due to the prolonged position on the back and the effect of the anesthetic on the intercostal muscles, a woman may find it difficult to breathe. In this case, oxygen is prescribed through a special mask.
When an anesthetic is injected into the veins of the epidural space, dizziness, palpitations, metallic taste in the mouth, tongue numbness. In order to prevent these unpleasant sensations, a test dose is first administered to the woman before the entire volume of the anesthetic is administered.
Sometimes the effect of the anesthetic can only extend to one half of the body. This can be easily corrected by pulling the catheter back a little.

Contraindications for epidural anesthesia are:

sepsis;
skin infection at the site of the intended injection;
violation of blood clotting (before epidural anesthesia, a blood test for clotting is performed);
bleeding;
neurological diseases;
patient's refusal of anesthesia.

For small operations carried out in the third trimester, it is possible to use and other types of local anesthesia. At this time, they are less dangerous than at the beginning of pregnancy, because the risk to the baby decreases as it develops.

What to do if you are injured or have a question about emergency surgery?

In any situation, do not forget to tell the doctors that you are pregnant, indicate the date and tell if you have a aggravated obstetric history (complications during preparation for pregnancy or complications of this and previous pregnancies). Your escorts should also be aware of this.

If you are offered hospitalization, do not refuse, just ask to be taken to a multidisciplinary hospital, where, in addition to a specialist in your illness, there will be obstetrician-gynecologists.

Do not be afraid if, with severe pain, the ambulance doctors give you an injection of Morphine or Promedol: these narcotic analgesics have been studied very well, and it has been proven that they do not harm the baby, and you will reduce the risk of miscarriage due to adrenaline and its derivatives that accumulate in the body from pain and increase the excitability of the uterus. Both the mother and the child do not become addicted to narcotic analgesics in such a short period.

Tell the anesthesiologist everything about your chronic diseases and your pregnancy, including the presence, intolerance not only to drugs, but also to food and smells, because he will have to choose the method of anesthesia during the operation.

What to expect during the operation

Immediately before the operation, Ranitidine is prescribed once or twice to reduce the acidity of the gastric juice and reduce the risk of burns from the gastric juice of the upper respiratory tract in case of unexpected vomiting during anesthesia. In this dosage, it usually does not affect the development of the child's nervous system.

Whenever possible, pregnant women are regional (epidural, conduction) anesthesia. And if it is impossible to use this method, multicomponent balanced anesthesia is performed with artificial ventilation of the lungs through a special tube inserted into the trachea (endotracheal tube).

Mask anesthesia, in which the anesthetic enters the body through the respiratory tract, pregnant women are not made because of the high risk of vomiting and getting it into the respiratory tract (aspiration).

Nitrous oxide, used by inhalation - using a mask, with constant use can provoke a miscarriage or damage. However, in low concentrations (the ratio to the oxygen content is 1:1) and for a short time, it is nevertheless prescribed during surgery. In this mode, it does not have time to act negatively, but causes good sleep, relaxes muscles, including the uterus.

Ketamine (Calypsol)- an anesthetic that is usually used for intravenous anesthesia - is used in the first and second trimester in small doses only for special indications and in combination with other drugs, as it increases the tone of the uterus. In the third trimester, its negative effect decreases.

Working with pregnant women, the anesthesiologist chooses the tactics of anesthesia and such anesthetic drugs that meet the following principles:

maximum child protection
support for normal placental blood flow,
decrease in excitability and decrease,
support for the sustainable functioning of the mother's body in the face of changes associated with pregnancy.

In any case, if there is a need for surgical intervention, the doctor chooses one or another method of anesthesia, depending on the patient's condition, the duration and characteristics of the proposed surgical intervention, the capabilities of this anesthesiology department, therefore it is impossible to unambiguously name the optimal method for such cases.

If you need surgery, you must follow all the recommendations of the anesthetist and other doctors, take the drugs that you are prescribed. If you have doubts about them, discuss it again with your doctor. Remember that almost all medicines say that it is not recommended to take them during pregnancy. But when the issue of your health and life is being decided, as well as the health and life of the baby, taking certain drugs is possible - of course, only under the control and supervision of your doctor.

The main thing is caution!

Thus, surgical methods of treatment and their anesthesia for a pregnant woman are complex and dangerous, but sometimes they cannot be dispensed with. There is only one way out in this situation: take care of yourself! Try to deal with your chronic diseases requiring surgery even before pregnancy. Do not forget about dental problems: sadly, one of the reasons for abortions is dental intervention during pregnancy, especially acute conditions, that is, dental diseases that cause toothache. Their treatment is usually also associated with pain. However, most of these diseases can be prevented by treatment before the examination.

Try to avoid dangerous places. If you are employed in production, ask the management to comply with the Labor Code and transfer to a quiet area. Please note that a car is not the safest place in the city, and even if an ace is driving your car, it is possible that a reckless scorcher will turn out to be your neighbor on the track. During pregnancy, it is worth sacrificing panache for convenience: hide thin hairpins, high heels and slippery soles away in the closet. Wear comfortable and stable shoes. Reduce for yourself, and for the unborn child, the risk of injury in the apartment (sharp corners, boxes falling out of the mezzanine, swinging ladders and stools, etc.).

But if the need for surgical intervention nevertheless arose, do not pull, contact the doctors. Take care of yourself and your baby.

Dmitry Ivanchin
anesthesiologist-resuscitator,
Senior Physician of the Operations Department of the Emergency Center of the Moscow Department of Health

Sometimes the health of a pregnant woman requires surgery. And this, as you know, is possible only with the use of anesthesia. According to statistics, about 2% of women are exposed to anesthesia during pregnancy. But can pregnant women get anesthesia?

Is it possible or not

Surgery during pregnancy may be needed for a variety of reasons. Most often, pregnant women undergo surgery due to injuries. Also, surgical intervention is necessary for acute diseases of the organs, in particular the peritoneum, exacerbation of chronic diseases. In addition, often during pregnancy, a woman's teeth deteriorate. And some manipulations require the use of anesthesia. In such situations, the use of anesthesia is necessary.

Anesthesia can harm a developing baby at any stage of pregnancy. Some anesthetics contribute to the appearance of defective cells, as a result of disruption of cell division processes. Also, anesthesia can lead to disruption of biochemical metabolic reactions, slowing down cell growth. Especially dangerous is the use of anesthesia in the early stages of pregnancy (weeks 2-8), when all the internal organs and systems of the fetus are laid. In addition, it is not recommended to perform surgery using anesthesia after the 28th week of pregnancy. This can provoke the onset of premature birth.

The impact of some anesthesia drugs can slow down the metabolism of oxygen between the body of the mother and child. In addition, with the slightest violation of the barrier function of the placenta in the body of the fetus, anesthetics can linger for a long time, having a negative impact on its development. Therefore, whenever possible, doctors try to postpone the operation for a period of 14-28 weeks.

If it is necessary to use anesthesia during pregnancy, specialists try to perform the following tasks:

delay surgery for a period of minimal risk (14-28 weeks of pregnancy);
perform surgery and anesthesia in the shortest possible time;
correctly choose the method of anesthesia, taking into account the individual characteristics of the woman's health and the course of her pregnancy.

The method of anesthesia and pain relief drugs are chosen by the doctor depending on the duration of pregnancy, the expected volume of intervention and the duration of the operation, and the individual characteristics of the woman. An important task in this case is the maximum protection of the fetus, maintaining normal placental blood flow, reducing the tone and excitability of the uterus, and maintaining pregnancy.

Types of anesthesia during pregnancy

Specialists distinguish between such types of anesthesia as local, regional, general.

Local anesthesia

Most safe during pregnancy. This type of anesthesia can be used both independently and in conjunction with other types. Local anesthesia is the temporary pain relief of a small area of the body by injecting a local anesthetic. As a rule, local anesthesia is used for minor operations, for example, in the treatment of teeth, opening of abscesses. Very thin needles are used to administer the anesthetic, so the injection process itself is almost painless.

Most often, drugs such as Lidocaine, Ultracaine, Ubistezin are used as an anesthetic for local anesthesia used for an expectant mother. These drugs are difficult to penetrate through the maternal placenta to the fetus, and, therefore, can not cause much harm to the child.

Although local anesthesia is most preferred during pregnancy, in some cases it can lead to side effects. First of all, there is a risk of developing an allergic reaction to the anesthetic drug. In addition, sometimes there is a loss of consciousness, convulsions, and cardiac arrhythmias.

Regional anesthesia

If it is impossible to perform surgery under local anesthesia, the doctor decides on the use of regional anesthesia (epidural and spinal). The use of this type of anesthesia leads to the switching off of the sensitivity of a certain part of the patient's body. As anesthetics, the same drugs are used as in the case of local anesthesia. During regional anesthesia, the doctor injects around a group of nerves, thus providing a loss of sensation in any part of the body.

During pregnancy, it has almost the same effect on the body of the mother and fetus, as well as local. Side effects of this method of anesthesia are also identical to the side effects of local anesthesia.

General anesthesia

In some cases, a pregnant woman can undergo surgery only with the use of general anesthesia. General anesthesia, or anesthesia, involves turning off the patient's consciousness. Anesthesia is inhalation and intravenous.

Preparations for inhalation anesthesia are administered to the patient along with oxygen when inhaled through an endotracheal tube or an anesthetic mask (at the doctor's choice). Most often, Halothane, Ftorotan, Izobluran are used as a means for such anesthesia. These drugs can in rare cases cause disturbances in uteroplacental blood flow due to vasodilation. In the last months of pregnancy, nitrous oxide can be used. But due to toxicity, it is strictly forbidden to take it at the beginning of pregnancy.

Unfortunately, not every pregnancy proceeds equally well. Anesthesia during pregnancy is possible, the second trimester of pregnancy is considered the most “safe”. But it is important to weigh all the risks.

Yes, indeed there are different situations in which you cannot do without using . What to do? Let's sort it out in order.

Reasons for needing anesthesia

According to statistics, about 2-3% of women during childbearing need surgical intervention using. Most often this concerns dental problems or surgical problems.

I can definitely say anesthesia during pregnancy is justified in cases where there is a real threat to the life of the expectant mother and urgent action is inevitable. However, if the situation allows you to make the necessary manipulations in a planned manner, the operation will definitely be postponed for a period after childbirth.

Without delay, despite the pregnancy, we take the patient for surgery if:

appendicitis (its main threat is the development of peritonitis with a fatal outcome);
other tumors of different etiology;
cysts;
extensive life-threatening injuries;
isthmic-cervical insufficiency - here treatment must be carried out just to save the pregnancy.

In this video you will see footage of a real operation performed on a pregnant woman.

In my practice, there were 2 patients with appendicitis during pregnancy who were successfully operated on under epidural anesthesia. They gave birth to their healthy babies at term.

Possible consequences after anesthesia

Alas, we are not Gods, so we cannot predict how anesthesia will affect pregnancy and the further development of the baby. Numerous studies on this topic say this:

The probability of a miscarriage or a missed pregnancy is no more than 6%. It is especially dangerous in the early stages, for the first time 8 weeks, during the formation of the main organs.
The likelihood of termination of pregnancy due to the operation performed under anesthesia. Makes 8%.

By and large, medicinal medicines used as medicines are fairly safe. Theoretically, anesthesia in the early stages of pregnancy can be carried out, but you need to choose drugs and anesthesia techniques with particular seriousness and full awareness of your actions.

It must be remembered that there is always a risk. The highest risk of using anesthesia during pregnancy is in the first trimester, when the internal organs are laid. The third trimester is also dangerous, because. surgery can cause premature birth.

It is because of the high risks of using anesthesia during pregnancy that doctors strongly recommend a thorough examination before planning a pregnancy. Show yourself to a dentist, a surgeon, if you know about some chronic diseases - conduct additional examinations, this way you will protect yourself and your unborn baby.

A few words about anesthesia during pregnancy

We can definitely say that the local conductor, made with drugs that include adrenaline, negatively affects early pregnancy. It causes a violation of blood flow to the placenta. In dentistry, one of the most popular drugs is Ultracaine. However, it is absolutely impossible to use it, since it contains adrenaline.

What types of drugs can be used?

The choice of medicines depends entirely on the state of health, the characteristics of the body. But as a rule, the following tactics are used:

Morphine, Promedol - these anesthetics at minimal doses do not harm the fetus.
Ketamine - long-term use causes an increase in uterine tone.
Local anesthesia through the use of Lidocaine. The drug crosses the placenta, but is rapidly excreted from the fetus.
In emergency operations for health reasons for the mother - intubation multicomponent anesthesia with relaxants. There is no longer any talk of saving the pregnancy. This method of anesthesia is used if it is necessary to perform an abdominal operation to remove an ectopic pregnancy.

And there are such "miracles", the doctors took a very big risk.

Stay healthy and have an easy pregnancy.

None of us is immune from health problems, and expectant mothers often worry about this kind of trouble. Especially serious diseases sometimes require urgent surgical intervention, which causes a lot of questions and worries, since treatment, especially anesthesia, is not particularly desirable during pregnancy. But it is not worth delaying the operation, if it is urgent and urgent. Here you are, as they say, a double-edged sword.

The mother's body during pregnancy works in a special mode, the composition of the blood changes, the load on all organ systems increases. Chronic diseases can worsen and go to the stage when urgent surgery is required. Also, the help of a surgeon may be needed in case of an unforeseen injury or dental problem. Therefore, doctors must be extremely careful not to harm either the mother or the child, their work is only equivalent to jewelry.

At what stage of pregnancy is anesthesia safest for the unborn child?

During the operation, the responsibility lies not only with the surgeon, but also with the anesthesiologist, he needs to very accurately calculate the dose of anesthesia, taking into account the gestational age, fetal sensitivity, placental permeability, and possible consequences. An incorrectly selected dose of anesthesia during pregnancy can cause violations in the development of the child, its metabolism, in especially severe cases, provoke deformity or death of the baby. A particularly dangerous period for the introduction of anesthesia is 2-8 weeks inclusive. From week 28 until the end of the gestation period, the threat is also increased. If surgical intervention is necessary and there is an opportunity to drag out time, then doctors recommend the period from 14 to 28 weeks for operations, at which time the uterus does not react so strongly to external influences, and the main organs of the baby are already formed.

What types of anesthesia are acceptable for pregnant women

The most suitable for safety is the method of regional anesthesia. In this case, anesthesia is administered over the membrane of the spinal cord, while the mother remains conscious, the lower part of the body becomes anesthetized. But options are not excluded when there are contraindications to such a method, for example, neurological diseases, or it cannot be applied due to the duration of the operation. Therefore, doctors have to use multi-component balanced anesthesia, while artificial ventilation is needed. Before the operation, it is necessary to prescribe drugs that help reduce the acidity of gastric juice so that vomiting does not occur.

The drugs used for anesthesia will depend on your timing, condition and complexity of the operation. For small operations, Lidocaine is usually used, which provides local anesthesia, it breaks down rather quickly and does not have time to harm the fetus. Ketamine is prescribed for intravenous anesthesia, but it is used in small doses and carefully, since it is able to increase the tone of the uterus, but in the third trimester its negative effect becomes more weakened. Nitrous oxide is used in combined anesthesia, but very rarely and for a short time, this drug is harmful to a small organism. If the expectant mother suffers from severe pain, then Morphine or Promedol can be used for injections, they are the least dangerous and almost do not cause malformations in the child. Of course, you must be extremely careful and prevent the occurrence of such health situations. If the inevitable happened, then you should trust only experienced and qualified specialists.