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Anesthesiology/IV Sedation when pregnant

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QUESTION: Hello - I am 16 weeks pregnant. During my first prenatal exam, I had a breast exam and the OB found a multilobular mass that she wanted me to get checked. I went to the breast surgeon and she wants to take it out. I asked about anesthesia when pregnant and she said it was safe. She spoke with the OB as well and the OB said it was safe as well. I always heard that it was bad during pregnancy. This is considered an elective surgery, since it is not a true emergency. I am tore if I should go through with it.

I should note that I had fibroid adenomas removed from both breasts in 2011 - all benign. Surgeon believes this one is benign too but not positive.

Is it safe to get general anesthesia when pregnant in second trimester? Doc said it would be a twilight sedation but I'm still not convinced.

Any info and advice would be appreciated. Thanks!

ANSWER: General anesthesia during the second trimester is considered safe.  But in your case the biopsy of the breast mass can be done entirely under local anesthesia, which will  present a minimum risk to both you and the fetus---obviating the need for a "general". Many anesthesiologists also utilize small amounts of narcotic medication during the biopsy which can alleviate pain/anxiety and present no danger to the unborn child as well;  I'd tell them I'd like as little as possible if I were you, though.  This is not the case with many other anesthetic-related medications.  Make sure you discuss the matter well in advance of your surgery with both the anesthesiologist and the surgeon.  Would a simple needle biopsy done by a radiologist under local with ultrasound guidance (to verify a benign mass) be a better option?

---------- FOLLOW-UP ----------

QUESTION: Thank you for your response - I appreciate it.

I did speak with the surgeon and she said that because the mass is behind the nipple, that getting to it with just local probably is not an option. She does not want to interfer with my ability to breastfeed if she cannot take it out properly.  She said that the procedure will be local, but will also have the anesthesiologist adminster propofol as a sedative. Do you know if this is considered safe?

I also spoke with one of the anesthesiologists and they said they don't have my specific record yet (they will the day prior to surgery) but they will get direction from the surgeon as to what to give. They did say they will give as little as possible since I'm pregnant.

So is the best thing I can do is ask them to do as much local as possible and as little sedative as possible and insist on only light, conscious sedation (not moderate, not heavy and no general)?? I do meet with them both prior to surgery.

Any advice would be fantastic. Thanks!

Answer
The surgeon you've chosen is not well-trained in the use of local anesthetics. Unfortunately, that is becoming more and more typical.....probably for a number of reasons, but beyond the scope of the answer to your question.  Propofol is safe, but far from optimal (it crosses the placental barrier).  You've already asked them to "use as much local as possible"--and have been told that for some reason (???) it will interfere with breast feeding. So reread the first part of my answer and best of luck to you and your baby.

Anesthesiology

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JM Starkman, MD

Experience

Over twenty-five years of adult and pediatric, inpatient and outpatient clinical anesthesia practice--some private, some group.

Organizations
American Association of Physicians and Surgeons. My county medical society.

Publications
[not a researcher]

Education/Credentials
American medical school graduate. Board Certified. Fellowship trained Cardiovascular and Pediatric anesthesia subspecialist.

Past/Present Clients
Over 20,000 anesthetics, the majority of which have been personally managed, with less than 5% consisting of supervising nurse anesthetists or in-training resident physicians.

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