Is it possible to administer local anesthesia to pregnant women? Dental treatment during pregnancy with anesthesia Pregnancy and anesthesia consequences

Medical statistics show that 2% of pregnant women need to perform some kind of surgical intervention related to acute diseases, injuries or the need for dental treatment. In some cases, anesthesia is used to eliminate pain, in others local anesthesia is used, the choice is made individually in each specific case.

When is anesthesia used during pregnancy?

Unfortunately, the happy state of expecting a baby in some pregnant women is overshadowed by the development of acute diseases that require urgent surgery and, of course, pain relief. It is well known that any operation and anesthesia contain a certain amount of risk for an ordinary patient. During pregnancy, this risk increases - both for the fetus and for the woman herself.

And yet, despite all the risks, the doctor is obliged to choose the lesser of two evils, because in any case, anesthesia during pregnancy is associated with operations that are performed for health reasons in the following cases:

• acute appendicitis;
• acute cholecystitis;
• peritonitis;
• intestinal obstruction;
• bleeding of various etiologies;
• acute gynecological pathology (ovarian cyst torsion);
• injuries of the abdominal and thoracic cavities;
• development of abscesses, phlegmon, purulent pleurisy.

Sometimes general anesthesia can be used for various manipulations and diagnostic procedures. For example, in the case of esophagogastric bleeding, gastroscopy is performed under anesthesia.

It is extremely rare to use anesthesia in dental practice. In the vast majority of cases, dental anesthesia in pregnant women is performed using local technology.

Advice: when pain syndrome or in case of injury, pregnant women should not take any analgesics, sedatives, or hypnotics on their own without the knowledge of a doctor. They can “erase” the manifestations of the disease, and also provide Negative influence for the fruit In these cases, you should immediately consult a doctor.

How does anesthesia affect the mother and fetus?

It is quite true that there are no harmless medicines, or, as they say in everyday life, one medicine heals, and another cripples. This is quite true in relation to anesthesia. General anesthesia affects the nervous, vascular, respiratory and endocrine system, on metabolism, on the functioning of the liver and kidneys.

But the question is that such anesthesia is nothing more than a vital necessity, and it is performed in pregnant women only during operations that have vital indications. Here, as they say, there is nowhere to go, and the choice is clear. Basically, modern technologies prevent any serious and lasting consequences of anesthesia for the body, and it is quickly cleansed and restored.

As for the unborn child in the womb, anesthesia poses a much greater danger for him, especially in early stages. Any negative effects in the first trimester, including narcotic drugs, sedatives, analgesics, can affect the formation of fetal organs and subsequently various congenital anomalies can form.

For more later pregnancy, that is, after 3 months, the fetus is already fully formed, that is, it is already real little man with the functioning of all organs and systems. At these times there is no need to worry about anomalies, but the consequences may manifest themselves in the form of hypoxia and developmental delays.

Advice: Once a situation has arisen where an operation under anesthesia is necessary for a pregnant woman, we must overcome all fears and realize that this choice is being made in the name of preserving life, and possible consequences anesthesia in in this case secondary. Moreover, modern anesthesia technologies are more gentle, and it is possible to eliminate negative consequences.

How to choose anesthesia during pregnancy

The basic principle of pain management during pregnancy is to make maximum use of local anesthesia. The best option For both the mother and her unborn baby, epidural anesthesia is the injection of an anesthetic around the dura mater of the spinal cord. This method does not produce pronounced general intoxication, but only temporary side effects in the form of nausea, changes in blood pressure, and so on.

When there is a question of serious abdominal interventions, when muscle relaxation is necessary, anesthesia is used. There are many types of it - mask, intravenous, intubation. Various narcotic substances are used - nitrous oxide, fluorotane, calypsol. For pregnant women, anesthesia is selected individually - neuroleptanalgesia with drugs that do not affect the tone of the uterus and do not interfere with the blood circulation of the placenta.

An example of such a drug is calypsol, which is used for short-term intravenous anesthesia and is subsequently quickly eliminated from the body. In any case, the choice of anesthetics and their combination are selected individually, depending on the nature and duration of the upcoming operation.

In dentistry, when urgent dental treatment is necessary in pregnant women, anesthesia is used extremely rarely; local anesthetics are used - lidocaine, ultracaine and others.

Anesthesia during pregnancy is dictated by necessity - life-saving interventions. Qualifiedly performed by specialists, it does not carry dangerous consequences for the body.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!

No matter how hard a woman tries to be careful and closely monitor her health during pregnancy, it happens that she needs urgent surgical help. Meanwhile, any surgical intervention and the associated use of anesthetics always carries a certain risk for the patient, and during pregnancy, anesthesia becomes doubly dangerous, since in this case the health of not only the mother, but also the unborn child is at risk. What can anesthesia lead to and what methods of pain relief can be used during this period?

How does anesthesia affect pregnancy?

Typically, during gestation, doctors try to avoid surgical interventions due to the potential danger from the use of anesthetics. If possible, surgical operations are postponed until the baby is born.

The use of anesthesia during pregnancy is permitted in the following cases:

• Acute dental problems (tooth extraction, pulpitis);
• Injuries;
• The need for emergency surgery (appendicitis, breast tumor, ovarian cyst);
• Exacerbation chronic diseases.

It is known that any medications, including anesthetics, can negatively affect the development of the fetus at any stage. In particular, anesthesia during pregnancy can cause serious disturbances in the functioning of the body, severe deformities, asphyxia and subsequent death of the child in the event of hypoxia in the mother. In addition, the use of medications in this group in some cases leads to an increase in uterine tone, which threatens premature birth or miscarriage.

The most dangerous is the use of anesthesia in the early stages of pregnancy, between 2 and 10 weeks of gestation. It is during this period that the formation of organs and systems of the embryo occurs. It is also not recommended to administer anesthetics to pregnant women in the third trimester, as this may cause premature onset. labor activity. Basically, doctors try to carry out any surgical interventions in the second trimester, when the placenta reliably protects the baby from any external influences, and quite a lot of time remains before birth

How does anesthesia affect pregnancy? Generally speaking, according to statistics, the use of anesthetics when carrying a baby is not associated with major risks:

• The incidence of congenital pathologies with a single use of anesthesia does not exceed the rates of occurrence of similar anomalies in pregnant women who have not been subjected to anesthesia;
• The probability of fetal death ranges from 6-11%;
• The risk of premature birth due to the use of anesthesia during pregnancy is on average no more than 8%;
• Level maternal mortality during surgery does not differ from similar estimates among non-pregnant women.

However, in the first and third trimester, expectant mothers are usually operated on under general anesthesia only for health reasons. Simple manipulations are performed using local anesthesia during pregnancy. However, recent studies show that most painkillers are completely safe for both the woman and the unborn child. According to experts, the development of abnormalities in the fetus is often not caused by the anesthetic itself. Important has an anesthesia technique: a woman in a position should not be allowed to experience a sharp decrease in the level of oxygen in the blood and a drop in blood pressure.

Dental anesthesia during pregnancy: what you need to know?

A pregnant woman should take special care to monitor her oral health, since caries and other diseases of the teeth and gums are a source of constant infection. However, many expectant mothers are sure that dental anesthesia during pregnancy can harm the baby, so they are often afraid to go to the dentist.

Currently, there are many drugs specifically designed to provide pain-free dental procedures. Modern anesthesia used for dental treatment during pregnancy is completely safe for both expectant mother, and for the child. Today, for this purpose, medications are used that do not contain components that have a vasoconstrictor effect and are able to overcome the fetoplacental barrier.

The most effective and completely safe means Ultracaine is used for local anesthesia during pregnancy. This drug is quickly eliminated from the body, and its use cannot harm the health or development of an unborn child. Primacaine is also used to numb teeth during dental procedures. The doctor prescribes the required dose of the selected drug individually, depending on the stage of pregnancy, age and general health of the patient.

Important information

In conditions requiring surgical intervention for health reasons, potent drugs can be used for anesthesia during pregnancy: morphine, promedol or ketamine in combination with glycopyrrolate. Most safe method Regional anesthesia (epidural or spinal) is considered pain relief for expectant mothers.

To administer the anesthetic in this case, a special needle is used, which is inserted into the spinal canal through the intervertebral foramen. The drug is delivered through a catheter to where the nerve roots that carry pain impulses pass through the spinal cord. If the use of regional anesthesia is not possible, doctors may opt for combined anesthesia with artificial ventilation. 4.9 out of 5 (25 votes)

Pregnancy is a special state of the female body when it experiences double the load and requires a careful and attentive attitude towards itself, because another life is developing inside. This is truly a miracle, and in order to preserve it and not cause harm, throughout the entire period of bearing a child, a woman must take care not only of herself, but also of the well-being of her baby. Special attention should be given to health and if any problems occur, then treatment should be carried out only under the supervision of a doctor and only with specially selected drugs that are absolutely harmless to developing fetus or their effect is minimal. This article will focus on the use of anesthesia during pregnancy. Much research has been devoted to this issue. After all, any surgical intervention is impossible without pain relief. But even today, when science has moved far ahead, there are no completely safe anesthetics. They all have their own toxicity threshold, which is regulated by the dosage of the drug. Therefore, the use of anesthesia during pregnancy poses a serious challenge for the anesthesiologist: to perform anesthesia and at the same time minimize negative impact for the fruit To do this, the permeability of the placenta to the anesthetic, the condition of the child, as well as the possible consequences of the administered drugs on its further development must be taken into account. Of course, the expectant mother needs to be extremely careful and monitor her health in order to avoid the need to use anesthesia during pregnancy. But, unfortunately, this is not always possible. A woman can receive a serious injury that requires surgery, and the development of appendicitis and other diseases cannot be prevented. internal organs, very often during pregnancy teeth begin to hurt, which also requires a medical solution and in some cases it is impossible to do without pain relief.

Anesthesia during pregnancy

It is necessary to clearly understand that any operation during pregnancy is performed only when the patient’s condition requires emergency medical care and threatens her life. In another case, all planned surgical measures are carried out after delivery.

But if you still have to undergo surgery, then local anesthesia during pregnancy is preferable, but this does not mean that it is absolutely harmless. But when correct use the chances of complications will be minimal.

The use of anesthetics in the first and second trimesters of pregnancy poses a particular danger to the fetus, since it is during this period that the child’s organs are formed, and the drugs used for pain relief penetrate well through the placenta and can cause inhibition of cell development. In addition, anesthetics disrupt placental and uterine blood flow, which affects the child’s nutrition.

At the same time, there is a certain danger for women. When using anesthetics, she experiences a surge of adrenaline, which can provoke termination of pregnancy. In addition, vomiting and vomit entering the lungs is possible.

Due to such a wide range possible complications, in the first two trimesters, according to vital signs, pregnant women are operated on under general anesthesia.

Minor surgical operations can be performed under local anesthesia (for example, dental procedures), when the anesthetic is injected directly into the area of ​​​​the intended intervention. But in this case, it is important that the woman warns about her pregnancy and the doctor uses drugs that do not contain adrenaline, because this can cause a miscarriage.

Regarding the third trimester, the risk to the baby’s life when using anesthesia during this period is even greater, since significant physiological changes in the body (displacement of organs abdominal cavity, compression of blood vessels, etc.), therefore, in the case of an urgent need for extensive surgical intervention, the question is to first perform a caesarean section under local anesthesia, and only then carry out the necessary actions under general anesthesia. But, of course, everything is determined on an individual basis. When many factors are taken into account:

• gestational age and fetal development level;
• degree of risk;
• pregnant woman's condition;
• clinical indications;
• wishes of the woman or her relatives (if the patient is unconscious).

Local anesthesia during pregnancy

Epidural anesthesia during pregnancy is considered the safest. It is also used during natural birth And caesarean section. It is a regional type and is performed by inserting a catheter into the epidural space in the spinal canal. A potent painkiller is injected through it. This anesthesia allows, if necessary, to administer an additional dose of the drug and monitor the patient’s condition.

This procedure is performed only by a highly qualified specialist. The effect of the substance begins in twenty to thirty minutes.

After using epidural anesthesia, the following consequences may occur:

• headache, dizziness;
• skin itching;
• labored breathing;
• cardiopalmus;
• numbness of the tongue, etc.

Also in the third trimester, you can use other methods of local anesthesia (conductor, spinal anesthesia).

The main thing to remember is that the drugs used at any stage of pregnancy should not contain adrenaline, the increase of which in the body can lead to termination of pregnancy.

General anesthesia and pregnancy

General anesthesia during pregnancy is used only in emergency cases when the use of other methods of pain relief is impossible. No matter how frightened we are by the very thought of anesthesia and its consequences on the body of the unborn baby, its use is still acceptable. Of course, the approach should be somewhat different than when administering anesthesia to another patient. First of all, it is necessary to choose the right drugs, with minimal toxic risk for the fetus and mother, and also take into account the duration of pregnancy (this also has its own nuances), then weigh the possible risks and be prepared to eliminate the consequences. In general, if we talk about the effect of anesthesia on the female body during pregnancy, the risks are the same as for any other woman.

As for the baby, provided that the correct anesthetics are used (without adrenaline) and the administration of anesthesia is strictly controlled (sudden jumps and drops in blood pressure should not be allowed, blood oxygen saturation should be strictly monitored during the operation), the risks are minimal. Of course the percentage possible problems with fetal development or miscarriage there is, but they do not exceed six percent, of which about twelve occur in the first trimester. Therefore, in the first eight weeks, general anesthesia is practically not given, since it is during this period that the main life-supporting systems are formed in the fetus. It is used only in emergency situations when a woman’s life is at stake.

Mortality during anesthesia pregnant and non-pregnant women appear to be the same. There is also insufficient evidence to support the idea that any particular anesthetic technique induces premature birth. Ketamine at a dose above 1 mg/kg in the 1st trimester can increase myometrial tone.

Sendak believes that any substance that easily penetrates the central nervous system can also enter the fetus. Intravenous sedatives can cross the placental barrier. Water-soluble, highly ionized drugs, such as muscle relaxants, overcome this with difficulty. Bupivacaine is so highly protein bound that it is not readily available for passage through the placenta. Substances with a molecular weight of more than 60 or 700 overcome it with difficulty.

Friedman reviewed the association of anesthetics with congenital anomalies. The table below shows the results for women who received anesthesia for early stage pregnancy.

One disease control center in USA believes that the offspring of mothers exposed to anesthesia in the 1st trimester have a higher risk of hydrocephalus and eye defects. A large follow-up study has demonstrated the safety of nitrous oxide in early pregnancy.

A) Nitrous oxide and pregnancy. Nitrous oxide is used by 35-50% of dentists in the United States. There are more than 175,000 dental assistants, 80,000 dental hygienists and 15,000 female dentists, most of whom are of reproductive age. Equipment that can reduce worker exposure in dental offices by 90% or more is not always used.

The US Occupational Safety and Health Administration does not provide maximum exposure limits for nitrous oxide, so its use is virtually unlimited. Although the US National Institute for Occupational Safety and Health recommended a level of 25 ppm in 1977, many dental offices continue to maintain levels of 100 ppm when ventilation is provided and even above 1000 ppm when it is not. It is possible that exposure to high concentrations of this anesthetic reduces fertility.

b) Local anesthesia during pregnancy. The advantages of regional anesthesia during childbirth and abortion include good pain relief, weakening of the secretion of catecholamines, stabilization of activity of cardio-vascular system, prevention of hypo- and hyperventilation and the absence of a depressing effect on the fetus and newborn. The procedure involves inserting a needle into the area where the epidural venous plexus is located.

Epidural hematomas are rare. The risk of their formation increases with therapeutic hepatitis, and such anesthesia is not recommended for women in labor suffering from it.

During childbirth and abortion, paracervical is usually used. perineal, epidural and spinal blockade. Contraindications to regional anesthesia include patient refusal, infection at the site of planned needle insertion, sepsis, active neurological disease, and congenital or acquired bleeding diathesis. Relative contraindications include decreased intravascular volume, severe anemia, fetal pathology, history of problems with regional anesthesia, and emotional or psychiatric disorders.

With paracervical anesthesia during an abortion in the first trimester, fatal outcomes are possible. They were observed after an overdose of lidocaine, which led to seizures and cardiac and respiratory arrest. Lidocaine blood levels at autopsy were within the toxic range.

V) Prevention of poisoning by anesthetics in pregnant women. Minimum effective volumes and concentrations of anesthetics should be used. The recommended maximum doses should not be exceeded. The amount of the product is selected taking into account the patient’s body weight.

Before injection, it is necessary to ensure aspiration of the local anesthetic, although this does not preclude careless intravascular injection. Localization of the anesthetic can be facilitated by vasoconstrictors, such as adrenaline. The patient should be questioned about previous negative reactions to such a procedure and find out if she has a family history of indications of pseudocholinesterase deficiency. Women with severe liver disease are at increased risk of intoxication.

G) Anesthesia-inducing agents. In the first trimester of pregnancy and during full-term delivery, thiopental is transferred from the maternal bloodstream to the placental tissues. Possible weakening of perfusion of the genitourinary organs.

- Ketamine. Rapidly transferred across the placenta.

- Etomidate. Safe and effective induction during cesarean section.

- Propofol. Penetrates through the placenta. No negative effects on the baby were noted. More research is needed.

- Benzodiazepines. Penetrate through the placenta.

d) Inhalational anesthetics during pregnancy:

- Nitrous oxide. Penetrates through the placenta. It has no obvious teratogenic effect.

- Halothane. Studied only in laboratory animals.

- Fentanyl, sufentanil. The mother has delayed gastric emptying, chest wall rigidity, and difficult ventilation during induction, and the newborn has chest wall rigidity. No teratogenic effects were observed with drug use.
Succinylcholine hydrochloride and pancuronium cross the placenta. Vecuronium bromide passes through it more poorly, while atracurium and curare pass through it poorly.

e) Lactation during pregnancy. Inhalational anesthetics usually do not pose a risk to a nursing infant. Nursing mothers in need of surgery usually tolerate a 12-24 hour break from feeding. During this time, almost all of the anesthetic is eliminated from their blood.

and) Spinal anesthesia during pregnancy. Spinal anesthesia in obstetrics differs from that performed in non-pregnant patients. Reduced doses of the topical agent are required and its distribution into the cerebrospinal fluid is less predictable. This procedure is more likely to cause hypotension, spinal headaches, and opioid side effects (eg, respiratory depression) in pregnant women than in others.

The fetus may be adversely affected by a drop in maternal blood pressure and inadequate vasoconstrictors. During pregnancy, it may be technically more difficult to find the subarachnoid space due to increased lumbar lordosis.