Surgery: Considerations in Pregnant Patients


Hand Surgery: Considerations in Pregnant Patients


Humbyrd CJ, Laporte DM (The Johns Hopkins Univ, Baltimore, MD) J Hand Surg 37A:1086-1089, 2012ยง



D.J. Smith, Jr., MD



Evidence Ranking


C



Expert Rating


2



Abstract




Timing, Monitoring, Anesthesia, and Positioning


If possible, nonurgent surgery should be done in the second trimester when preterm contractions and spontaneous abortion are less likely. Fetal heart rate should be monitored by Doppler before and after surgery for a previable fetus. Heart rate and contractions should be monitored before, after, and during (when feasible) surgery for a viable fetus. If intraoperative fetal monitoring is used, the patient should give consent for emergency cesarean delivery and the obstetrical team should be readily available.


The physiologic changes of pregnancy nearly all affect anesthesia. Managing the airway is vital, since pregnant patients have 20% greater oxygen consumption and 20% less pulmonary functional residual capacity. Apnea causes a rapid decline in oxygenation. Oropharyngeal swelling and a smaller glottis opening can interfere with intubation and ventilation. Pregnancy reduces lower esophageal sphincter tone, increases gastric acidity, and delays gastric emptying, raising the risk for aspiration pneumonia.

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May 5, 2016 | Posted by in Aesthetic plastic surgery | Comments Off on Surgery: Considerations in Pregnant Patients

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