what is the effect of local anesthesia on the respiratory, cardiovascular system in pregnancy women ? and what about the fetus safety?
I researched a lot for this topic and I cannot find satisfied articles and information
According to BNF 68 it stated that during pregnancy
"large doses can cause fetal bradycardia; large doses during delivery can cause neonatal respiratory depression, hypotonia, or bradycardia after paracervical or epidural block ".
The answer above refers to regional anesthesia.
Since local anesthesia is given for relatively short duration with a local effect only, the influence over the fetus not more than minimal
I fully agree with Avi Harlev. Local application of anesthetic drugs can be considered as safe in pregnancy
Local anaesthesia is safe in pregnancy - even with intravascular infiltration the risk will be greater for the mother than the fetus with normal amounts used. Direct fetal intravascular administration of LA will cause bradycardia / asystole with volumes varying with gestation but typically of at least 2-20ml from 11-24 weeks so even inadvertent intravascular infiltration to the mother is unlikely to pose any risk to the fetus
While regional anesthesia can be safe to use the impact to the fetus is not always readily appreciated. The un-medicated laboring mother produces endorphins and has some hyperventilation to offset the acidosis and hypoxic components as well as the discomfort of being "squashed" by the uterus that is experienced by the fetus during intense uterine contractions. When maternal pain is blocked her adaptations for her discomfort are decreased if not abolished entirely however the process nevertheless continues for the fetus - now without any accommodation. The longer laboring mothers receive regional relief the more potential for embarrassment the fetus can experience - so as a neonatologist I see babies whose activity is reduced, cord blood ph is lower, some appear stunned or "hyperalert" -they are nothing like the robust infant of a "natural" childbirth. Epidurals/spinals when poorly timed can prolong labor can change the course of fetal rotation and may end up necessitating an operative delivery - ie vacuum or, forceps assisted delivery or even Csection deliveiry), The use of regional anesthesia should be carefully considered and should never be accepted as routinely necessary.
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