Alternatives for anaesthesia during pregnancy
If possible, surgery and the necessary anesthesia during pregnancy is avoided. Risks that cannot be calculated are too great for the elective procedure. If an operation during pregnancy cannot be avoided, regional anesthesia is the method of first choice.
Regional anesthesia also carries risks, but is much better tolerated by the pregnant woman and the child. Studies show that the risk of dying from anesthesia is about half as high when using regional anesthesia as when using general anesthesia. Nevertheless, many pregnant women are operated on every year using general anesthesia because an alternative is not available for many operations.
Although anesthesia should always be carefully considered during pregnancy, dental procedures are usually not a problem. However, in any case, the dentist must be informed about the pregnancy in order to be able to consider the particularities of anaesthesia during pregnancy. In contrast to major surgery under general anesthesia, which should not be used in the first months of pregnancy, dental procedures can usually still be performed at the dentist’s office, since local anesthesia of the oral cavity is sufficient and no riskier general anesthesia is necessary.
Actually, local anesthesia does not involve the use of a drug in the bloodstream, but there is still a risk of cross-over, which has an impact on the choice of the drug for local anesthesia, as one must be prepared for this incident as well. The usual medications (=local anesthetics) are very fat soluble and can very easily pass into the child’s circulation via the umbilical cord. Therefore, pregnant women should choose anaesthetics which are not so easily fat-soluble and which cannot enter the child’s circulation in case the anaesthetic enters the mother’s circulation.
Usually, local anesthetics are mixed with drugs that constrict the blood vessels. This additive prevents excessive spreading of the drug as well as major bleeding. In this case, adrenaline derivatives should be used during pregnancy, as some other substances can promote contractions.
If all these special features are taken into account, there is usually nothing to prevent dental procedures under local anesthesia. If the fear of surgery plays an important role, sedatives can be used. Benzodiazepines such as diazepam have proven to be particularly suitable.
These can be used for a short time during pregnancy to reduce the stress reactions of the expectant mother, as these are also felt by the unborn child. If fear of surgery plays another important role, sedatives can be used.Benzodiazepines such as diazepam have proved to be particularly suitable. These can be used for a short time during pregnancy to reduce the stress reactions of the expectant mother, as these are also felt by the unborn child.
