Local anesthesia during early pregnancy. Surgical interventions during pregnancy: an anesthesiologist's view

None of us are immune from health problems; often these kinds of troubles also worry expectant mothers. Particularly serious diseases sometimes require urgent surgical intervention, which raises a lot of questions and worries, since treatment, especially anesthesia, is not particularly desirable during pregnancy. But there is no point in delaying the operation if it is urgent and urgent. Here you have, as they say, a double-edged sword.

During pregnancy, the mother's body works in a special mode, the composition of the blood changes, and the load on all organ systems increases. Chronic diseases may worsen and progress to a stage where immediate surgery is required. Also, the help of a surgeon may be needed in case of an unexpected injury or dental problem. Therefore, doctors must be extremely careful not to harm either the mother or the child; their work is comparable only to jewelry.

At what stage of pregnancy is anesthesia safest for the unborn child?

During the operation, responsibility lies not only with the surgeon, but also with the anesthesiologist; he needs to very accurately calculate the dose of anesthesia, taking into account the gestational age, fetal sensitivity, placental permeability, and possible consequences. An incorrectly selected dose of anesthesia during pregnancy can cause disturbances in the development of the child, its metabolism, and in especially severe cases, provoke deformity or death of the baby. A particularly dangerous period for administering anesthesia is considered to be 2-8 weeks inclusive. From the 28th week until the end of the pregnancy, the risk is also increased. If surgical intervention is necessary and there is an opportunity to delay time, then doctors recommend the period from 14 to 28 weeks for operations, during which time the uterus does not react so strongly to external influences, and the baby’s main organs are already formed.

What types of anesthesia are acceptable for pregnant women?

The most suitable method in terms of safety is regional anesthesia. In this case, anesthesia is administered over the membrane of the spinal cord, while the mother remains conscious, the lower part of the body becomes anesthetized. But options cannot be excluded when there are contraindications to this method, for example, neurological diseases, or it cannot be used due to the duration of the operation. Therefore, doctors have to use multicomponent balanced anesthesia, which requires artificial ventilation. Before the operation, medications must be prescribed that help reduce the acidity of gastric juice to prevent vomiting.

The drugs used for anesthesia will depend on your age, condition and complexity of the operation. For minor operations, lidocaine is usually used, which provides local anesthesia; it breaks down quite quickly and does not have time to harm the fetus. Ketamine is prescribed for intravenous anesthesia, but it is used in small doses and carefully, since it can increase the tone of the uterus; in the third trimester, its negative effects become more weakened. Nitrous oxide is used for combined anesthesia, but very rarely and for a short time; this drug is harmful to a small organism. If the expectant mother suffers from severe pain, then Morphine or Promedol can be used for injections; they are the least dangerous and almost do not cause developmental defects in the child. Of course, you must be extremely careful and prevent such health situations from arising. If the inevitable happens, then you should trust only experienced and qualified specialists.

Is it possible to have dental anesthesia during pregnancy? This is the question every expectant mother asks when she gets into the dentist’s chair.

As you know, any drug, especially one introduced into the body by injection, brings not only benefits, but also some harm. And for a pregnant woman, the danger is higher due to the possible adverse effects of medications on the child’s body. This article discusses the issues of local anesthesia during pregnancy, the choice of anesthetics and methods of pain relief.

As you know, the main indication for pain relief is pain or discomfort during medical procedures. However, it is better not to undergo local anesthesia for pregnant women unless unnecessary.

In addition, the stage of pregnancy must be taken into account. It is believed that drugs cause the least harm to the body of the expectant mother and child in the second trimester (4-6 months). In the first trimester, the laying of organs and systems occurs, in the second – their planned development, in the third – formation.

Therefore, the administration of local anesthetics in the first and third trimester is not recommended (with the exception of emergency conditions, such as inflammatory diseases requiring surgical intervention). In addition to toxic effects, anesthetics with large amounts of adrenaline used in the last months of pregnancy can cause premature birth.

When sanitation of the oral cavity in the first months of pregnancy and the need to remove individual teeth as planned, the intervention is postponed for several months until the second trimester.

Choice of drugs

If it is necessary to perform local anesthesia for a pregnant woman, you need to choose the anesthetic wisely. Thus, the use of drugs with high concentrations of vasoconstrictors is not recommended.

The best option is 3% Scandonest (mepivacaine) or varieties of articaine with minimal adrenaline content (for example, Ultracaine D-S or Ubistezin D-S, vasoconstrictor concentration 1:200000).

Anesthesia techniques

Pregnant women can undergo both infiltration and conduction anesthesia, but dentists prefer the first option. Conduction anesthesia is not used unless absolutely necessary.

conclusions

• Dental anesthesia can be administered to pregnant women; the best time for this is the second trimester. However, in conditions requiring urgent surgical interventions (opening of ulcers, removal of aggravated teeth), anesthesia is performed in any month of pregnancy.
• The drugs of choice are Scandonest, Ultracain D-S and Ubistezin D-S.
• Preference is given to infiltration anesthesia.

FAQ

First of all, one that does not injure the gums during use. At the same time, the quality of oral hygiene depends more on whether the teeth are brushed correctly than on the shape or type of toothbrush. As for electric brushes, for uninformed people they are a more preferable option; although you can clean your teeth efficiently with a simple (manual) brush. In addition, a toothbrush alone is often not enough - floss (special dental floss) must be used to clean between the teeth.

Mouthwashes are additional hygiene products that effectively cleanse the entire oral cavity of harmful bacteria. All these products can be divided into two large groups – therapeutic and preventive and hygienic.

The latter include mouthwashes that eliminate unpleasant odors and promote fresh breath.

As for therapeutic and prophylactic ones, these include rinses that have anti-plaque/anti-inflammatory/anti-carious effects and help reduce the sensitivity of hard dental tissues. This is achieved due to the presence of various biologically active components in the composition. Therefore, the mouthwash must be selected individually for each individual, as well as toothpaste. And since the product is not washed off with water, it only consolidates the effect of the active ingredients of the paste.

This type of cleaning is completely safe for dental tissues and causes less damage to the soft tissues of the oral cavity. The fact is that in dental clinics a special level of ultrasonic vibrations is selected, which affects the density of the stone, disrupts its structure and separates it from the enamel. In addition, in places where tissues are treated with an ultrasonic scaler (this is the name of the device for cleaning teeth), a special cavitation effect occurs (after all, oxygen molecules are released from water droplets, which enter the treatment area and cool the tip of the instrument). The cell membranes of pathogenic microorganisms are ruptured by these molecules, causing the microbes to die.

It turns out that ultrasonic cleaning has a comprehensive effect (provided that really high-quality equipment is used) both on the stone and on the microflora as a whole, cleansing it. But the same cannot be said about mechanical cleaning. Moreover, ultrasonic cleaning is more pleasant for the patient and takes less time.

According to dentists, dental treatment should be carried out regardless of your situation. Moreover, a pregnant woman is recommended to visit the dentist every one to two months, because, as you know, when carrying a baby, the teeth are significantly weakened, suffer from a deficiency of phosphorus and calcium, and therefore the risk of developing caries or even tooth loss increases significantly. To treat pregnant women, it is necessary to use harmless anesthesia. The most appropriate course of treatment should be selected exclusively by a qualified dentist, who will also prescribe the required medications that strengthen tooth enamel.

It is quite difficult to treat wisdom teeth due to their anatomical structure. However, qualified specialists successfully treat them. Wisdom teeth prosthetics are recommended when one (or several) adjacent teeth are missing or need to be removed (if you also remove a wisdom tooth, there will simply be nothing to chew on). In addition, removal of a wisdom tooth is undesirable if it is located in the correct place in the jaw, has its own antagonist tooth and takes part in the chewing process. You should also take into account the fact that poor quality treatment can lead to the most serious complications.

Here, of course, a lot depends on a person’s taste. So, there are absolutely invisible systems attached to the inside of the teeth (known as lingual), and there are also transparent ones. But the most popular are still metal bracket systems with colored metal/elastic ligatures. It's really fashionable!

To begin with, it is simply unattractive. If this is not enough for you, we present the following argument - tartar and plaque on the teeth often provoke bad breath. Is this not enough for you? In this case, we move on: if tartar “grows”, this will inevitably lead to irritation and inflammation of the gums, that is, it will create favorable conditions for periodontitis (a disease in which periodontal pockets form, pus constantly flows out of them, and the teeth themselves become mobile ). And this is a direct path to the loss of healthy teeth. Moreover, the number of harmful bacteria increases, which causes increased dental caries.

The service life of a well-established implant will be tens of years. According to statistics, at least 90 percent of implants function perfectly 10 years after installation, while the service life is on average 40 years. Typically, this period will depend both on the design of the product and on how carefully the patient cares for it. That is why it is imperative to use an irrigator during cleaning. In addition, it is necessary to visit the dentist at least once a year. All these measures will significantly reduce the risk of implant loss.

Removal of a dental cyst can be done therapeutically or surgically. In the second case, we are talking about tooth extraction with further cleaning of the gums. In addition, there are modern methods that allow you to save the tooth. This is, first of all, cystectomy - a rather complex operation that involves removing the cyst and the affected root tip. Another method is hemisection, in which the root and a fragment of the tooth above it are removed, after which it (the part) is restored with a crown.

As for therapeutic treatment, it consists of cleaning out the cyst through a root canal. This is also a difficult option, especially not always effective. Which method should you choose? This will be decided by the doctor together with the patient.

In the first case, professional systems based on carbamide peroxide or hydrogen peroxide are used to change the color of teeth. Obviously, it is better to give preference to professional whitening.

Even pregnant women sometimes have to undergo surgical operations when anesthesia is necessary. Starting from a banal tooth extraction to more complex abdominal operations, no one is immune from this and it is clear that they are all carried out using anesthesia. Whether anesthesia can be used during pregnancy and how it can affect its further course is far from an idle question, which, of course, worries every woman if she is to undergo such manipulations.

Is it possible to have anesthesia during early pregnancy?

Like any other medications, anesthesia turns out to be most dangerous in the initial stages, when the initial formation of the most important organs and systems of the unborn baby occurs. Any disruption of this process can lead not only to the development of intrauterine pathologies, but even to spontaneous abortion. Anesthesia can also be dangerous at a period above 28 weeks, since at this time the size of the uterus is already too large, it compresses the blood vessels and puts pressure on the rest of the abdominal organs. During pregnancy, this can lead to breathing problems for both the woman and her unborn baby. Therefore, if possible, all surgical interventions are recommended to be carried out during the period from 14 to 28 weeks, of course, taking into account the individual characteristics of the course of pregnancy.

The expectant mother begins to breathe differently, all her organs work differently, from the liver or kidneys to the digestive and cardiovascular systems. Even her blood changes its original composition. Therefore, if it is possible to postpone such an impact, if the operation is planned and not urgent, then, of course, it should be postponed. If this is impossible to do, then it is obvious that you have to take risks.

Most often, pregnant women have to go under the surgeon’s knife due to various injuries or in the process of exacerbation of various diseases, which, under the influence of the restructuring that occurs in the body, unfortunately, are not so uncommon. Quite often, dental problems also become aggravated, because a pregnant woman needs an increased amount of calcium in the body, and if there is not enough calcium, then, first of all, it is the expectant mother’s teeth that suffer. And, of course, dental treatment often has to be carried out under anesthesia.

A particularly difficult task in this matter falls on the shoulders of a specialist anesthesiologist, who has to perform very complex, almost, so to speak, jewelry work and keep in mind that anesthesia penetrates the placental barrier. This means it is necessary to use an anesthetic that is safest for the developing tiny organism.

What anesthesia is most suitable for pregnant women?

Most often, epidural anesthesia is used for pregnant women, which numbs the nerve endings located in the spinal column. This anesthesia is considered the safest, while the pregnant woman remains conscious, and the risk to the unborn baby is minimized. However, epidural anesthesia during pregnancy is not always possible; in some cases, for example, in the case of impaired hemostasis or sepsis, as well as in some other diseases during pregnancy, it is necessary to use general multicomponent anesthesia, while the woman’s lungs are subjected to artificial forced ventilation.

Dental treatment

Sometimes pain relief is also required when visiting the dentist. In such situations, the safest anesthetics are increasingly used. Their risk to the fetus is minimal, but it still exists. Therefore, you need to adhere to the general rules - it is not recommended to treat teeth in the first trimester, which lasts until the 12th week. It is best to go to the dentist at 12-24 weeks, he will administer local anesthesia.

There is one more important point. Many expectant mothers are afraid of harming their baby and refuse anesthesia altogether. It is not right. After all, pain is no better than anesthesia. It increases the tone of the uterus and its vessels, a huge amount of hormones are released into the woman’s blood. The child may suffer from this. Therefore, pain cannot be tolerated.

If the operation is relatively minor, for example, tooth extraction or treatment of some minor injuries, then local dental anesthesia is used during pregnancy using Ultracaine, Primacaine and other similar drugs that act in a limited area and practically do not penetrate the placental barrier, and is eliminated from the body quite quickly.

Preparing for surgery with anesthesia during pregnancy

As a rule, before a planned operation, a woman is offered two options:

• You can spend the night at home and come to the hospital in the morning.
• Or go to bed the day before and spend the night in the room.

Most patients choose the first option - they say, it’s calmer at home, and the family will support. In practice, everything turns out completely differently. Close people are worried, and this excitement, of course, is transmitted to the woman. She doesn't sleep well at night. The road to the hospital is also very nerve-wracking. The woman experiences a lot of negative emotions. This leads to only one thing: the anesthesiologist has to increase - sometimes several times - the dose of the drug.

But the more anesthetic is administered, the higher the risk for the child. And you need to take care of him and yourself. Therefore, it is best to go to the hospital. Before going to bed, doctors can give a light sleeping pill, and in the morning give injections of specially selected sedatives. As a result, a calm, well-rested woman will go to the operation. In this case, the anesthesiologist will be able to get by with a minimal dose of pain medication.

The choice of the drug itself is also important. It should not reduce uterine blood flow, increase uterine tone, and should not have a toxic effect on the fetus. There are few such drugs. Typically, narcotic analgesics and sodium thiopental are used to anesthetize a pregnant woman. In most cases, calypsol, sombrevin and diprivan are contraindicated. But sometimes they are also prescribed. It all depends on the specific situation, so you should talk to an anesthesiologist before surgery. He must explain the choice of drug and give full information about it.

Typically, anesthetics without adrenaline or with its minimal content are used for pregnant women. This hormone increases the tone of the uterus, increases blood pressure, and makes the heart beat faster. All this is of no use to the expectant mother.

Local anesthetics of the amide group are recognized as the safest during pregnancy. These include articaine, brilocaine, primacaine, septonestubistezin, ultracaine DS. All of these drugs have minimal effects on the fetus.

By the way, most anesthetics enhance the gag reflex. This should be taken into account by women suffering from toxicosis. It is better for them not to eat anything before visiting the dentist. The installation of the back of the chair also plays an important role. It is best to sit in a semi-sitting position. Horizontal body position provokes nausea.

When a pregnant woman is faced with the need for dental treatment, she is faced with the question: is anesthesia in dentistry safe during pregnancy in the 1st, 2nd and 3rd trimester? The answer is not so simple and depends on a number of conditions, including the state of health and well-being of the expectant mother and baby.

For fear of harming their child in one way or another, women often refuse dental procedures altogether, thereby exposing the child to even greater risk. When solving any medical problem, it is always necessary to take into account the potential risk/benefit ratio and make a choice based on these parameters.

Is it possible to have anesthesia during pregnancy?

In most situations, dental treatment during pregnancy with anesthesia is not only permitted, but necessary. With severe pain, “stress” hormones from the adrenal glands are released into the bloodstream. Under their influence, blood vessels narrow, blood pressure increases, which can cause fetal hypoxia or premature birth. You can do without anesthesia when treating uncomplicated caries, but only if the pain sensitivity threshold is high enough.

The optimal time for dental interventions when carrying a child is the 2nd trimester (from 14 to 28 weeks), during this period the risk of complications is minimal. In the 1st trimester there is a risk of fetal malformations. 3 – the risk of premature birth increases, especially if the procedure is perceived by the pregnant woman as stressful. Nevertheless, there are diseases for which dental care is strictly required at any stage of pregnancy, and there are manipulations that can easily be postponed until better times.

Permitted and undesirable dental procedures during pregnancy

Allowed	Undesirable
Treatment of complicated and uncomplicated caries, pulpitis with or without local anesthesia	Dental implantation
Treatment of stomatitis, periodontitis	Installation of braces
Tooth extraction	Prosthetics for cosmetic purposes
Tartar removal	X-ray of dentition
Use of medications and products for topical use as prescribed by a doctor	Self-use of medications and local remedies without medical advice

Safe drugs

Doctors still have no consensus regarding the safety of local anesthetics during pregnancy. Many point out the risk of using anesthesia with adrenaline in the early stages. However, the danger of this substance is somewhat exaggerated. Contrary to popular belief, it not only does not increase the tone of the uterus, but even decreases it. The only threat is its vasoconstrictor effect and the possibility of increasing blood pressure, but for this it must be used in high dosages, which dentists do not work with.

The following types of local anesthetics are acceptable for pregnant women:

• Lidocaine is a drug that is relatively safe for mother and child. It passes through the placenta, but is quickly removed from the baby’s body without causing harm to him. However, its analgesic effect is lower, and the risk of developing allergies is higher than that of more modern means.
• , Primacaine are articaine-based anesthetics containing low concentrations of adrenaline and practically do not penetrate the placental barrier. Widely used in dental practice, they are also allowed during breastfeeding.
• Mepivacaine without adrenaline is used if a pregnant woman has diseases of the cardiovascular, endocrine, respiratory systems - arterial hypertension, arrhythmias, bronchial asthma, hyperthyroidism, pheochromocytoma. The average duration of the effect of this drug is not always sufficient - about 30 minutes.

Are there any contraindications?

The only absolute contraindication to local anesthesia during pregnancy is individual intolerance to the anesthetic substance - in this case it is replaced with another drug.

The remaining contraindications are relative. The issue of using anesthesia in each case is decided individually and depends on the general health of the pregnant woman and on the period at which the intervention is planned. Relative contraindications include:

• disorders in the blood coagulation system due to the risk of bleeding;
• neurological diseases (multiple sclerosis, epilepsy, myasthenia), in which the decision on anesthesia must be agreed with a neurologist;
• inflammatory process in the area of ​​the oral mucosa into which an injection must be given;
• 2–8 weeks of pregnancy due to the risk of affecting the formation of internal organs:
• 3rd trimester of pregnancy due to the risk of premature birth.

About anesthesia...

In contrast to local anesthesia, general anesthesia during pregnancy is an extremely undesirable procedure at any stage. Here is a far from complete list of possible consequences of anesthesia:

• suffocation of the fetus due to a decrease in blood pressure in the mother under the influence of general anesthesia: blood enters the placenta more slowly and gas exchange between mother and child is disrupted;
• delayed mental development in the baby;
• the formation of congenital developmental anomalies in the fetus under the influence of anesthesia drugs;
• increased risk of miscarriage or premature birth.

Therefore, general anesthesia is used only for life-threatening conditions of the pregnant woman. Such situations are not typical for dental practice, so in this case local anesthesia is used, which is not so harmful.

Video: about anesthesia during pregnancy.