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Anesthesiology/Pregnant and sedation

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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. They plan on local with IV sedation (twilight).

Is this a safe approach, granted that local isn't enough because of where the mass is?  I am terried of sedation if it's considered unsafe. I assume the minimal will be used, but still want your opinion.

Any info and advice would be appreciated. Thanks!

Answer
Thank you for a most interesting question.

Generally speaking, we try not to administer intravenous sedation during the first trimester. The reason for this is that during that period the fetus is undergoing the formation of it's organs. We know that some sedatives can possibly be "teratogenic", or capable of causing abnormalities in the organ formation process. We also try to avoid sedation during the third trimester because of the risk of premature labor. The second trimester is probably the safest time to have procedures that are done under intravenous sedation, understanding that the risk can never be reduced to zero.

I do not know your age or your health history or the history of your female relatives. All of these factors can influence the timing of a breast biopsy. Younger women would probably have less of a chance of a malignancy but this would increase with age or if there is a strong family history of breast cancer.

I would recommend that you have a discussion with your surgeon to find out her level of suspicion concerning the mass and if she feels that she can safely postpone the procedure until you are somewhat further along in your pregnancy. If this is not possible than I would discuss this with your anesthesiologist (a physician who specializes in the administration of anesthesia) so that he or she can plan the safest anesthesia for your procedure.

Please let me know what you decide and how things go. I feel certain that things will go just fine and you will have a healthy baby.

Anesthesiology

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Charles T Porter Jr MD

Expertise

Questions in all fields of Anesthesiology except Pain Management.

Experience

I have been in the practice of Anesthesiology since 1981.

Organizations
American Society of Anesthesiologists, International Anesthesia Research Society, Texas Society of Anesthesiologists, Texas Medical Association

Education/Credentials
Graduate of the Citadel and the Medical University of South Carolina. Completed Anesthesiology residency at the Naval Medical Center San Diego, California. Board certified in Anesthesiology and a Fellow of the American College of Anesthesiologists.

Awards and Honors
Alpha Omega Alpha National Medical Honor Society 1978, Outstanding Graduate Anesthesiology Resident Naval Medical Center San Diego California

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