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Anesthesiology/Pregnancy and IV 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. I am persisting on local + light sedation if needed (not moderate, not heavy, not general).

Any info and advice would be appreciated. Thanks!

Answer
The level of sedation is somewhat irrelevant.  Light, moderate, deep all have equal risks related to pregnancy.  In some cases moderate and deep sedation can be more dangerous than general anesthesia.  If you can't tolerate the procedure with straight no Local (no sedation at all), then light sedation will not be satisfactory either.

Does this mass need to come out right now?  It may. Your age is a factor along with other risk factors for breast cancer.  The vast vast majority of these masses that are removed are benign.  However, in some cases they are malignant and this is the rare case they are concerned with.  I think it is important to review with them your individual risk factors and then proceed with anesthesia based on the recommendation of your anesthesiologist.  I do not agree that light, moderate or deep sedation are inherently safer than general anesthesia.  In pregnant patients I prefer general endotracheal anesthesia or straight local to decrease the risk of aspiration pneumonitis.

Dr. Russell

Anesthesiology

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Rex Russell

Expertise

Any question dealing with general anesthesia issues. With particular emphasis on regional anesthesia.

Experience

I am a board certified anesthesiologist, graduated from residency in 2004 from Johns Hopkins Hospital. I have since worked as an anesthesiologist first in the Air Force for three years and then most recently in Texas in Private Practice.

Organizations
Texas Medical Association Texas society of Anesthesiologists American Society of Anesthesiologists

Education/Credentials
BS, BYU MD, U of Texas, Galveston Intern-St. Joe's Hospital, Phx, AZ Internal Medicine Residency-Johns Hopkins Hospital, Baltimore, MD

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