Alumi Laparoscopic Discussion Board

Nitrous oxide in first trimester lap surgery ?
Discussion in 'All Categories' started by Avinash kumar singh - Aug 10th, 2016 6:17 am.
Avinash kumar singh
Avinash kumar singh
Can we use nitrous oxide (?teratogenic) in laparoscopic surgery during first trimester.is DVT prophylaxis necessary even in this trimester and in thin patients.
re: Nitrous oxide in first trimester lap surgery ? by Dr R K Mishra - Aug 12th, 2016 11:56 am
#1
Dr R K Mishra
Dr R K Mishra
Dear Dr Singh

Pregnancy is not a contraindication of laparoscopy but you are absolutely right that choice of anesthetic agent is a debatable topic. Nitrous oxide is avoided as animal studies provide evidence that it is a potent inhibitor of methionine synthase. However, currently, there is no evidence in human beings to suggest that this is clinically significant.

In pregnant women isoflurane and sevoflurane are suitable for day care anaesthesia. Sevoflurane has little more advantages of less airway hyper reactivity and quicker emergence and discharge and is the anesthetic agent of choice in pregnant women. Fetal well-being in pregnant women should be assessed by ultrasound or Doppler before and after laparoscopic surgery. Because of the increased risk of hypoxaemia, difficulties with intubation, acid aspiration and risks to the fetus, epidural anaesthesis can be selected over general anaesthesia whenever feasible but in laparoscopic surgery there are only few surgery which can be performed under these type of anaethesia.

As you know that Venous thromboembolism is a leading cause of disability and death in postoperative hospitalized laparoscopic gynecologic patients so prophylactic low molecular heparine is mendatory for for prolonged surgery long duration procedures. A patient whose Surgery lasting < 30 minutes in patients < 40 years with no additional risk factors may not need this prophylaxis. But Major surgery in patients >60 years plus prior history of thromboembolism, cancer, or molecular hypercoagulable state the prophylaxis is essential.

With regard

Dr R K Mishra
re: Nitrous oxide in first trimester lap surgery ? by Dr Imran Pathan - Aug 12th, 2016 12:00 pm
#2
Dr Imran Pathan
Dr Imran Pathan
You are correct sir, Isoflurane and Sevoflurane is less myocardial toxic for fetus also.
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