Can I have a local anesthetic during pregnancy?
Anaesthesia in a pregnant woman is also a speciality in the selection of drugs. The anaesthetic gas should be dosed lower in pregnant women, because the changes in the respiratory organs make them act faster. Laughing gas should be avoided for use as an inhaled anaesthetic gas in the anaesthesia of pregnant women, as there is a relative risk of miscarriage.
The risks associated with the use of drugs injected intravascularly into the vascular system lie in the need for accurate dosing of these substances. Overdosage can easily damage the fetus, whereas underdosage in the interest of the mother should be equally avoided. At the same time, it should be noted that the use of some anaesthetics may reduce or increase the muscle tension of the uterus and thus, under certain circumstances, contractions may occur during the operation, which may lead to abortion of the fetus.
Propofol has become the agent of choice for most anesthetics. There is insufficient data available on the possible consequences for the unborn child of an anesthetic with Propofol during pregnancy. For this reason, its use should only be recommended in absolutely necessary cases and the dose should be kept as low as possible.
Like many other drugs, Propofol can also enter the child’s bloodstream via the umbilical cord and placenta, thus also narcotizing the child to a certain extent and impairing its circulatory function. The reason for this is the high fat solubility of Propofol. On the one hand, this is necessary for Propofol to have a positive effect in the brain, where it causes loss of consciousness.
Unfortunately, this fat solubility is also the reason for the child’s anaesthesia, as fat-soluble drugs can enter the child’s circulation through the placenta. In general, the same side effects and complications apply to the anaesthesia of pregnant women as to healthy people. Anaesthesia is always a medical procedure and should not be performed without serious reason, especially during pregnancy.
In the special case of anaesthesia for pregnant women, there are other things to consider: Aortocaval compression syndrome is a known complication of late pregnancy. It is caused in about 16%-20% of all pregnant women by adopting the supine position. In this case, the uterus presses on two important large vessels of the body (aorta and vena cava) and can thus trigger severe side effects with shock symptoms.
Some anaesthesiological procedures, such as anaesthesia, favour the occurrence of this syndrome by means of usual positioning. If possible, the woman should therefore be positioned during a surgical procedure in such a way that the probability of spontaneous occurrence of the aortocaval syndrome remains as low as possible. Due to the changes in the abdominal cavity of a pregnant woman, aspiration of stomach contents during anesthesia is also more frequent.
For this reason, pressure on the abdomen during surgery should be avoided if possible and the risk of aspiration should be kept low by intubation. Performing the procedure while the upper body is elevated also reduces the risk. In pregnant women, it is especially important to keep an eye on the blood pressure during the operation, as a sudden drop in blood pressure can damage the fetus. The risk of a spontaneous abortion during anesthesia is another complication during anesthesia. Due to the use of the anesthetics, which are common placenta and thus also reach the fetus, as well as the stress caused by the procedure, a miscarriage of the child during the procedure cannot be excluded.
