Expert: Ronald Levy, M.D. - 4/12/2011

Question
I am currently in the position to decide whether or not to go ahead with a procedure.  I am almost 27 weeks pregnant and am suffering from hemorrhoids (prior to pregnancy) that are believed to be thrombosed.  I am under the care of a high risk OB due to previous losses.  This pregnancy is going normal and well.  The colon/rectal surgeon and my OB have ok'd a banding procedure to be performed under a mild sedation...what they are calling a twilight sleep.  I have had this before during a colonoscopy. However, I am terrified of the risk to my unborn baby.  Is this kind of sedation at all safe for pregnancy?  What sedation drug can be used safely, if any?  Are there studies to prove that no harm will come to the baby? The two doctors do not seem to be concerned, however, I have no contact for anesthesia to ask any questions.  Please help, any information you can provide will be greatly appreciated.

Answer
First of all, no one will guarantee that no harm will come to the baby. That being said, I would not be concerned either. The main problems with pregnancy happen during the first and last trimesters. In the first trimester is when organogensis occurs and you are at a higher risk of either malformations or abortions. In the third trimester you are concerned with premature labor. Also, during all of pregnancy there are certain drugs that you shouldn't use (e.g. tetracycline causes yellow teeth, etc). Since your anesthesiologist knows this he will use appropriate meds to make your procedure as safe as possible. Generally, if a procedure is purely elective (hernia, plastics) we recommend waiting until after delivery but as this is more urgent, I would proced with the procedure.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston