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Laparoscopic procedures during pregnancy and the risks of anesthesia: what does an obstetrician need to know?

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Abstract

Background

Nonobstetric surgery may be necessary during any stage of gestation.

Methods

The purpose of this article is to review the current recommendations (using Medline search for the relevant publications) for the perioperative anesthetic management of pregnant women undergoing laparoscopy for indications unrelated to pregnancy.

Results

The current estimates of the incidence of nonobstetric surgery in pregnancy range from 1% to 2%. Laparoscopy is the most common surgical procedure performed in the first trimester of pregnancy, whereas appendectomy is the most common procedure performed during the remainder of pregnancy.

Conclusions

In the past pregnancy was considered as an absolute contraindication to laparoscopy. However, recent years have brought an extensive experience with this technique during gestation.

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References

  1. Kuczkowski KM (2006) Nonobstetric surgery in the parturient: anesthetic considerations. J Clin Anesth 18:5–7

    Article  PubMed  Google Scholar 

  2. Ni Mhuireachtaigh R, O’Gorman DA (2006) Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth 18:60–66

    Article  PubMed  CAS  Google Scholar 

  3. Kuczkowski KM (2006) The safety of anaesthetics in pregnant women. Expert Opin Drug Saf 5:251–264

    Article  PubMed  CAS  Google Scholar 

  4. Naughton NN, Cohen SE (2004) Nonobstetric surgery during pregnancy. In: Chestnut DH (ed) Obstetric anesthesia: principles and practice. Elsevier Mosby, Philadelphia, p 255–272

    Google Scholar 

  5. Mazze RI, Kallen B (1989) Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol 161:1178–1185

    PubMed  CAS  Google Scholar 

  6. Brodsky JB, Cohen EN, Brown BW, Wu ML, Whitcher C (1980) Surgery during pregnancy and fetal outcome. Am J Obstet Gynecol 138:1165–1167

    PubMed  CAS  Google Scholar 

  7. Halkic N, Tempia-Caliera AA, Ksontini R, Suter M, Delaloye JF, Vuilleumier H (2006) Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy. Langenbecks Arch Surg 391:467–471

    Article  PubMed  Google Scholar 

  8. Mazze RI, Kallen B (1991) Appendectomy during pregnancy: a Swedish registry study of 778 cases. Obstet Gynecol 77:835–840

    PubMed  CAS  Google Scholar 

  9. Melnick DM, Wahl WL, Dalton VK (2004) Management of general surgical problems in the pregnant patient. Am J Surg 187:170–180

    Article  PubMed  Google Scholar 

  10. SAGES publication 0023. SAGES guidelines for laparoscopic surgery during pregnancy. Available at: http://www.sages.org/sg_pub23.html. Accessed October 1, 2002

  11. Kuczkowski KM (2005) Trauma during pregnancy: a situation pregnant with danger. Acta Anaesthesiol Belg 56:13–18

    PubMed  CAS  Google Scholar 

  12. Weinberg L, Steele RG, Pugh R, Higgins S, Herbert M, Story D (2005) The pregnant trauma patient. Anaesth Intensive Care 33:167–180

    PubMed  CAS  Google Scholar 

  13. Kunitz O, Rossaint R (2005) Anesthesia during pregnancy. Chirurg 76:737–743

    Article  PubMed  CAS  Google Scholar 

  14. Kuczkowski KM (2004) Trauma in pregnancy: perioperative anesthetic considerations for the head-injured pregnant trauma victim. Anaesthesist 53:180–182

    Article  PubMed  CAS  Google Scholar 

  15. Reisner LS, Kuczkowski KM (2003) Anesthetic considerations for complicated pregnancies. In: Creasy, Resnik, Iams (eds) Maternal-fetal medicine. Elsevier Science, Philadelphia, pp 1243–1260

  16. Kuczkowski KM (2004) Nonobstetric surgery during pregnancy: what are the risks of anesthesia? Obstet Gynecol Surv 59:52–56

    Article  PubMed  Google Scholar 

  17. Littleford J (2004) Effects on the fetus and newborn of maternal analgesia and anesthesia: a review. Can J Anesth 51:586–609

    Article  PubMed  Google Scholar 

  18. Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G (2005) Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 190:467–473

    Article  PubMed  Google Scholar 

  19. Kuczkowski KM, Reisner LS, Lin D (2004) Anesthesia for cesarean section. In: Chestnut DH (ed) Obstetric anesthesia: principles and practice. Elsevier Mosby, Philadelphia, pp 421–446

    Google Scholar 

  20. Kuczkowski KM, Reisner LS, Benumof LJ (2004) The difficult airway: risk, prophylaxis and management. In: Chestnut DH (ed) Obstetric anesthesia: principles and practice. Elsevier Mosby, Philadelphia, pp 535–561

    Google Scholar 

  21. Nuevo FR (2000) Anesthesia for nonobstetric surgery in the pregnant patient. In: Birnbach DJ, Gatt SP, Datta S (eds) Textbook of obstetric anesthesia. Churchill Livingstone, New York, pp 289–298

    Google Scholar 

  22. Rosen MA (1999) Management of anesthesia for the pregnant surgical patient. Anesthesiology 91:1159–1163

    Article  PubMed  CAS  Google Scholar 

  23. Duncan PG, Pope WDB, Cohen MM, Greer N (1986) Fetal risk of anesthesia and surgery during pregnancy. Anesthesiology 64:790–794

    PubMed  CAS  Google Scholar 

  24. Kuczkowski KM, Fernández CL, Pérez PT (2006) Pasaje Transplacentario de Drogas. In: Aldrete JA, Paladino MA (eds) Farmacología para Anestesiólogos, Intensivistas, Emergentologos y Medicina del Dolor, Corpus, Buenos Aires, Argentina, pp 629–647

  25. Gint T, Gregory MA, Oh TE (1990) The hemodynamic effects of propofol and thiopentone for induction of caesarean section. Anaesth Intensive Care 18:175–179

    Google Scholar 

  26. Alon E, Bali RH, Gillie MH, Parer JT, Rosen MA, Shnider SM (1993) Effects of propofol and thiopental on maternal and fetal cardiovascular and acid–base variables in the pregnant ewe. Anesthesiology 78:562–576

    Article  PubMed  CAS  Google Scholar 

  27. Dailland P, Cockshott ID, Lorzin JD, Jacquinot P, Jorrot JC, Devery J, Harmey JL, Conseiller C (1989) Intravenous propofol during cesarean section: placental transfer, concentrations in breast milk, and neonatal effects. A preliminary study. Anesthesiology 71:827–834

    Article  PubMed  CAS  Google Scholar 

  28. Gin T (1994) Propofol during pregnancy. Acta Anaesthesiol Sin 32:127–132

    PubMed  CAS  Google Scholar 

  29. Crawford ME, Carl P, Bach V, Ravlo O, Mikkelsen BO, Werner M (1989) A randomized comparison between midazolam and thiopental for elective cesarean section anesthesia. I Mothers. Anesth Analg 68:229–233

    Article  PubMed  CAS  Google Scholar 

  30. Bernstein K, Gisselsson L, Jaconsson T, Ohrlander S (1985) Influence of two different anaesthetic agents on the newborn and the correlation between foetal oxygenation and induction-delivery time in elective caesarean section. Acta Anaesthesiol Scand 29:157–160

    Article  PubMed  CAS  Google Scholar 

  31. Fujinaga M, Mazze RI (1986) Reproductive and teratogenic effects of lidocaine in Sprague–Dawley rats. Anesthesiology 65:626–632

    Article  PubMed  CAS  Google Scholar 

  32. Baden JM, Serra M, Mazze RI (1987) Inhibition of rat fetal methionine synthase by nitrous oxide: an in vitro study. Br J Anaesth 59:1040–1043

    Article  PubMed  CAS  Google Scholar 

  33. Boss GR (1985) Cobalamin inactivation decreases purine and methionine synthesis in cultured lymphoblasts. J Clin Invest 76:213–218

    Article  PubMed  CAS  Google Scholar 

  34. Hansen DK, Billings RE (1985) Effects of nitrous oxide on maternal and embryonic folate metabolism in rats. Dev Pharmacol Ther 8:43–54

    PubMed  CAS  Google Scholar 

  35. Leicht CH (1990) Anesthesia for the pregnant patient undergoing nonobstetric surgery. Anesthesiol Clin North Am 8:131–142

    Google Scholar 

  36. Reves JG, Glass PS, Lubarsky DA, Mcevoy MD (2005) Intravenous nonopioid anesthetics. In: Miller RD (ed) Miller’s anesthesia, 6th edn. Elsevier Churchill Livingstone, Philadelphia, pp 317–378

    Google Scholar 

  37. Fukuda K (2005) Intravenous opioid anesthetics. In: Miller RD (ed) Miller’s anesthesia, 6th edn. Elsevier Churchill Livingstone, Philadelphia, pp 379–428

    Google Scholar 

  38. Naguib M, Lien CA (2005) Pharmacology of muscle relaxants and their antagonists. In: Miller RD (ed) Miller’s anesthesia, 6th edn. Elsevier Churchill Livingstone, Philadelphia, pp 481–572

    Google Scholar 

  39. Magorian T, Flannery KB, Miller RD (1993) Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology 79:913–918

    Article  PubMed  CAS  Google Scholar 

  40. Eger EI (2005) Inhaled anesthetics: uptake and distribution. In: Miller RD (ed) Miller’s anesthesia, 6th edn. Elsevier Churchill Livingstone, Philadelphia, pp 131–154

    Google Scholar 

  41. Dullenkopf A, Gerber AC, Weiss M (2004) Nitrous oxide diffusion into tracheal tube cuffs: comparison of five different tracheal tube cuffs. Acta Anaesthesiol Scand 48:1180–1184

    Article  PubMed  CAS  Google Scholar 

  42. Kuczkowski KM, Eisenmann UB (2005) Nitrous oxide as a cause of internal iliac artery occlusion balloon rupture. Ann Fr Anesth Reanim 24:564

    PubMed  CAS  Google Scholar 

  43. Kuczkowski KM Anesthesia for the repeat Cesarean section in the parturient with abnormal placentation: is there cause for concern? Problem based learning discussions—2005 CD-ROM, American Society of Anesthesiologists Publication Department, October 2005

  44. Kuczkowski KM (2006) Anesthesia for the repeat Cesarean section in the parturient with abnormal placentation: what does an obstetrician need to know? Arch Gynecol Obstet 273:319–321

    Article  PubMed  Google Scholar 

  45. Fatum M, Rojansky N (2001) Laparoscopic surgery during pregnancy. Obstet Gynecol Surg 56:50–59

    Article  CAS  Google Scholar 

  46. Reedy MB, Kallen B, Kuehl TJ (1997) Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 177:673–679

    Article  PubMed  CAS  Google Scholar 

  47. Hunter JG, Swanstrm L, Thornburg K (1995) Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model. Surg Endosc 9:272–279

    PubMed  CAS  Google Scholar 

  48. Coleman MT, Trianfo VA, Rund DA (1997) Nonobstetric emergencies in pregnancy: trauma and surgical conditions. Am J Obstet Gynecol 77:497–502

    Article  Google Scholar 

  49. Mourad J, Elliott JP, Erickson L, Lisboa L (2000) Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs. Am J Obstet Gynecol 182:1027–1029

    Article  PubMed  CAS  Google Scholar 

  50. Firstenberg MS, Malangoni MA (1998) Gastrointestinal surgery during pregnancy. Gastroenterol Clin 27:73–78

    Article  CAS  Google Scholar 

  51. Goodman S (2002) Anesthesia for nonobstetric surgery in the pregnant patient. Semin Perinatol 26:136–145

    Article  PubMed  Google Scholar 

  52. Joris JL (2005) Anesthesia for laparoscopic surgery. In: Miller RD (ed) Miller’s anesthesia, 6th edn, Elsevier Churchill Livingstone, Philadelphia, pp 2285–2306

    Google Scholar 

  53. Czeizel AE, Pataki T, Rockenauer M (1998) Reproductive outcome after exposure to surgery under anesthesia during pregnancy. Arch Gynecol Obstet 261:193–199

    Article  PubMed  CAS  Google Scholar 

  54. De Perrot M, Jenny A, Morales M, Kohlik M, Morel P (2000) Laparoscopic appendectomy during pregnancy. Surg Laparosc Endosc Percutan Tech 10:368–371

    Article  PubMed  Google Scholar 

  55. Tracey M, Fletcher HS (2000) Appendicitis in pregnancy. Am Surg 66:555–559

    PubMed  CAS  Google Scholar 

  56. Reynolds JD, Booth JV, De la Fuente S, Punnahitanada S, Mcmahon RL, Hopkins MB, Eubanks WS (2003) A review of laparoscopy for non-obstetric-related surgery during pregnancy. Curr Surg 60:164–173

    Article  PubMed  Google Scholar 

  57. Fanzago E (2003) Anaesthesia for non obstetric surgery in pregnant patients. Minerva Anesthesiol 69:416–427

    CAS  Google Scholar 

  58. Jenkins TM, Mackey SF, Benzoni EM, Tolosa JE, Sciscione AC (2003) Non-obstetric surgery during gestation: risk factors for lower birthweight. Aust NZ J Obstet Gynaecol 43:27–231

    Article  Google Scholar 

  59. Kuczkowski KM (2004) Trauma in reproductive-age women. S Afr J Surg 42:32

    PubMed  CAS  Google Scholar 

  60. Crowhurst JA (2002) Anaesthesia for non-obstetric surgery during pregnancy. Acta Anaesthesiol Belg 53:295–297

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, University of California San Diego (UCSD) Medical Center, 200 W. Arbor Drive, San Diego, CA, 92103-8770, USA

    Krzysztof M. Kuczkowski

  2. Department of Reproductive Medicine, University of California San Diego (UCSD) Medical Center, San Diego, CA, USA

    Krzysztof M. Kuczkowski

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Correspondence to Krzysztof M. Kuczkowski.

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Kuczkowski, K.M. Laparoscopic procedures during pregnancy and the risks of anesthesia: what does an obstetrician need to know?. Arch Gynecol Obstet 276, 201–209 (2007). https://doi.org/10.1007/s00404-007-0338-0

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  • DOI: https://doi.org/10.1007/s00404-007-0338-0

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