Daughter had sedation for procedure, found out pregnant 2 days later...

jwk · Oct 25, 2004

My 20 year old daughter had her wisdom teeth out Thursday. She rec'd Versed, Propofol, and Fentanyl, per the dental assistant when I asked.
My question is, are these drugs suitable for early pregnancy? I work in telemetry, not anesthesia or OB, so I am not real knowledgeable on this. She is worried to pieces.
She will of course mention this to her OB but it will be a few days at least before she can get in.
Thanks in advance.

Fentanyl is OK at this stage.

Propofol is not approved for use in pregnancy, but lots of places use it anyway.

The main problem drug she received is Versed. It is contraindicated, particularly in early pregnancy because of an increased chance of birth defects. She should mention this to her OB at her first visit.

nilepoc · Oct 25, 2004

I recently did a case report on anesthesia in the first trimester. Currently the drugs you mention are not proven to cause teratogenicity (except nitrous which is a known teratogen). Including midazolam (versed) see this article (Goodman S. Anesthesia for nonobstetric surgery in the pregnant patient. Seminars in Perinatology. 26(2):136-45, 2002 Apr.).

The evidence is just not there according to what I have read. I would still advise her to seek the advice of an OBGYN as she would for her pregnancy anyway.

Please let us know what you find out.

Craig

BrandieRNq · Oct 25, 2004

I would like to say that my experience sounds much like hers as far as conscious sedation goes...I cried and cried for a long time...someone came in a short time later to explain "you might cry for no reason". This was appr. 7 years ago before I knew the difference between drugs...I am curious to know which one caused it. Also, I am VERY sensitive to meds, I am wondering if your daughter is the same. I just remember it being such an unexpected, strange reaction! (same as your daughter, no pain or discomfort, really unable to explain the reason for crying!) I recall me mom asking me again and again what was wrong...my answer was always a weeping "nothing"!

DutchgirlRN, ASN, RN · Oct 25, 2004

I used to work for an OB-GYN. We had a patient tell the doctor that she had done drugs up until the day she was supposed to start her period. The doctor told her not to worry that the embryo was not implanted deeply enough by that point to make any difference. Whether or not that's true I really don't know I just remember him telling her that. As for the crying, I did the same thing and so did my daughter. The dentist told us to expect it. Good Luck

gotosleep · Oct 25, 2004

I recently did a case report on anesthesia in the first trimester. Currently the drugs you mention are not proven to cause teratogenicity (except nitrous which is a known teratogen). Including midazolam (versed) see this article (Goodman S. Anesthesia for nonobstetric surgery in the pregnant patient. Seminars in Perinatology. 26(2):136-45, 2002 Apr.).
The evidence is just not there according to what I have read. I would still advise her to seek the advice of an OBGYN as she would for her pregnancy anyway.
Please let us know what you find out.
Craig

Exactly Craig....

The link between midazolam and teratogenicity is another one of those anesthesia old-wives tells. The only study that has implicated any link has widely been discredited a long time ago. Kind of like droperidol (at a reasonable dose) and cardiac arrhythmias.

jwk · Oct 25, 2004

Exactly Craig....
The link between midazolam and teratogenicity is another one of those anesthesia old-wives tells. The only study that has implicated any link has widely been discredited a long time ago. Kind of like droperidol (at a reasonable dose) and cardiac arrhythmias.

So do you give Versed to a woman whom you know to be pregnant during their first trimester? Or do you not, just in case there IS a risk?

AFWife · Oct 25, 2004

While I am not a nurse, I just thought I'd share my own experience. I had my gall bladder removed under full anesthesia when I was 6 weeks pregnant. All of my docs knew I was pregnant at the time. It was my choice to have surgery, and I knew the risks. The pain of my gallstones was much, much worse than any labor pains I had. I was on a PCA pump afterwards. After my surgery, they discovered I still had stones in the bile duct, as well as a small hole. So during an ERCP to place a stent and remove the rest of the stones, I was given versed, as well as something else that I can't recall the name of. During my hospital stay, I also had phenergan. Anyway, I guess my point is that even after all that, I have a perfectly normal and healthy 4 year old. Although one nurse told me that when she starts acting weird at 16 or so, I should tell her it's a result of all the drugs! :chuckle Just my $0.02 worth.

gotosleep · Oct 26, 2004

So do you give Versed to a woman whom you know to be pregnant during their first trimester? Or do you not, just in case there IS a risk?

I absolutely do not give versed to the first trimester parturient. In fact, I would have insisted on a serum/urine HCG prior to sedating his daughter. This has nothing to do with science. Just playing the CYA game unfortunately.

apaisRN, RN, CRNA · Oct 26, 2004

I absolutely do not give versed to the first trimester parturient. In fact, I would have insisted on a serum/urine HCG prior to sedating his daughter. This has nothing to do with science. Just playing the CYA game unfortunately.

Would you do this with any woman of child-bearing age?

gotosleep · Oct 26, 2004

Would you do this with any woman of child-bearing age?

unless....

menstrual period within 30 days of procedure.

history of hysterectomy or tubal ligation.