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Anesthesiology/Sedation and pregnancy

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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
Melissa,

Thank you for your questions.  I apologize for the delay in response.  I'll do my best to answer them.

16 weeks pregnant signifies you are roughly 4 weeks into your second trimester.  Current research (most all we have to compare to are animal studies at this time) suggests that any elective procedures be delayed until around 6 weeks postpartum.  Second trimester is preferred for semi-elective procedures.  Urgent surgery should not be delayed, however, secondary complications to mother and fetus should not be ignored.  That being said, most organogenesis (organ/system development) defects (related to exposure to teratogenic drugs) would occur within in the first trimester.  

So, the question of safety will continue to be studied.  Two main anesthetic drug I'd use, in this situation, should we need/decide to proceed, would be propofol and fentanyl.  Both used in clinical doses (for the purpose of keeping you comfortable during surgery) do not appear to show negative outcomes to fetus or mother, with the current literature out there.  With respect to local anesthesia injection into the region where mass is, is also considered a preferred alternative in conjunction with light sedation.  It's when you would require a deeper plane of anesthesia (general anesthesia) where concerns would arise...mostly dealing with keeping maternal blood pressure/fetal blood flow within baseline range.  

A good surgeon with a good field block (local anesthetic injected into/surrounding the surgical area) should allow you to have light/twilight anesthesia/sedation.  That being said, and despite everyone's best efforts, you as a patient are an individual, and what works for one, may not work for another, and your reaction to anesthesia has to be determined at the time of surgery.

If you have any further questions, or if I have not addressed fully your current inquiries, please do not hesitate to message me at any time.  

Thank you again, and good luck with your decision.

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Dino Kattato MSNA CRNA

Expertise

Former ICU/ER RN with several years of experience. I can answer questions relating to the CRNA education process, professional issues involved, as well as questions about adult and pediatric clinical anesthesia.

Experience

Level I regional Trauma center dealing with simple to complex patient populations of all ages. Experience with general anesthesia, spinal and epidural anesthesia, and total IV anesthesia for all surgical specialties including neuro, ortho, general surgery, vascular, electrophysiology, and VIR, with the exception of cardiac anesthesia. Ambulatory surgery center dealing mostly with ENT, plastics, and eyes (70%:30% peds:adults).

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AANA NYSANA

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AANA Journal February 2010 Feb;78(1):24-7. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Retrieve&list_uids=20977125&dopt=abstractplus

Education/Credentials
RN BSN MSNA ACLS/PALS BLS instructor

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