The pregnant patient (non-obstetric surgery)

Top concerns

1. 1.Aspiration risk from ~mid-second trimester: RSI + non-particulate antacid is the conventional approach
2. 2.Rapid desaturation: ↓FRC + ↑O₂ consumption — meticulous preoxygenation
3. 3.Aortocaval compression after ~20 weeks: left uterine displacement whenever supine
4. 4.Uteroplacental perfusion is pressure-dependent: treat hypotension early (phenylephrine first-line)
5. 5.MAC decreases ~30–40%; propofol/neuraxial dose requirements fall as well
6. 6.Fetal considerations: defer elective surgery; organogenesis (weeks ~3–8) is the highest-risk teratogenic window; perioperative fetal monitoring plan per OB consult

Drug do's and don'ts

• AVOIDNSAIDs (late pregnancy)— Premature ductus arteriosus closure; also oligohydramnios concerns.
• CAUTIONBenzodiazepine single doses— Old oral-cleft signal not supported for single perioperative doses, but minimize in first trimester where practical.
• PREFERNeuraxial technique— When surgery permits — minimizes fetal drug exposure and airway risk.
• PREFERPhenylephrine— First-line vasopressor for maternal hypotension.

Airway & positioning

• Anticipate difficult airway: mucosal edema, friable tissue — start with a 6.0–7.0 ETT and have smaller ready
• Ramped position + left uterine displacement simultaneously
• Limit airway instrumentation attempts; epistaxis risk with nasal approaches

Pearls

• Maternal oxygenation and pressure ARE fetal resuscitation.
• The safest anesthetic for the fetus is a hemodynamically boring one for the mother.

Suggested reading

• Chestnut's Obstetric Anesthesia, 6e
• ACOG Committee Opinion 775 (nonobstetric surgery in pregnancy)

Educational quick-reference only — defer to clinical judgment, institutional protocols, and the primary texts above.