A 28-year-old G2P1 at 34 weeks gestation requires emergency appendicectomy for perforated appendicitis. Which consideration is MOST critical when planning anaesthesia?

• A Spinal anaesthesia is absolutely contraindicated in pregnancy
• B Surgery should be delayed until 36 weeks to reduce fetal risk
• C Regional anaesthesia is preferred and general anaesthesia should be completely avoided
• D Rapid sequence induction with cricoid pressure; left lateral tilt to prevent aortocaval compression; avoid N₂O; fetal monitoring ✓

Explanation

Pregnant patients have increased aspiration risk (progesterone-reduced LOS tone, delayed gastric emptying, increased intragastric pressure from gravid uterus) — rapid sequence induction (RSI) with cricoid pressure is mandatory if general anaesthesia is used. Aortocaval compression by the gravid uterus causes significant reduction in cardiac output and uteroplacental perfusion — left lateral tilt of 15–20° or manual uterine displacement is required. N₂O (especially in early pregnancy) is associated with folate metabolism interference and should be avoided. Continuous fetal heart rate monitoring should be used. Emergency surgery cannot be delayed for fetal maturity considerations.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.