Peds rotation during first trimester

[aprilrain]

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I'm a current CA2 and just found out that I'm pregnant. I have a peds rotation coming up when I would be in my third month of pregnancy. I'm a little concerned about all of the inhalational exposure. Anybody have any suggestions or should I just ask the chiefs to switch my rotation? Thanks!

 

[AdmiralChz]

I'm a current CA2 and just found out that I'm pregnant. I have a peds rotation coming up when I would be in my third month of pregnancy. I'm a little concerned about all of the inhalational exposure. Anybody have any suggestions or should I just ask the chiefs to switch my rotation? Thanks!

You're an anesthesia resident - tell me, what is the risk of getting exposed to inhalational gas? Does it matter if it's a Sevo vs Nitrous or a combo? Have you looked up any evidence? Not trying to be a jerk or pimp you but I think you might be missing something.

 

[WholeLottaGame7]

You're an anesthesia resident - tell me, what is the risk of getting exposed to inhalational gas? Does it matter if it's a Sevo vs Nitrous or a combo? Have you looked up any evidence? Not trying to be a jerk or pimp you but I think you might be missing something.

Whatever it is, it's not zero. Certainly higher than the risk of MRI but we get pregnant residents and CRNAs out of there all the time for some reason. I don't think it's unreasonable to want to switch rotations.

 

[AdmiralChz]

Whatever it is, it's not zero. Certainly higher than the risk of MRI but we get pregnant residents and CRNAs out of there all the time for some reason. I don't think it's unreasonable to want to switch rotations.

Eh, by that logic we should get those pregnant or (really) those trying to be pregnant out of those rooms, or maybe any room where inhalational agent is used? Just preops for 9 months? Exaggerating of course - just use Sevo, not nitrous. Most women in my residency program had kids and we only had them avoid ortho joint rooms (methylmethacrylate), none had any issues doing Peds rooms. Two of the current Peds fellows here are pregnant as well, no work adjustments there.

Of course I say this from the perspective of a male, and haven’t really considered it as a resident personally.

 

[deleted875186]

Why not just ask to switch. I don’t think it would be a big deal. You’ll have to let everyone know anyway, so you can get out of being assigned any CT cases or casss woth a lot of fluoro.

I'm a current CA2 and just found out that I'm pregnant. I have a peds rotation coming up when I would be in my third month of pregnancy. I'm a little concerned about all of the inhalational exposure. Anybody have any suggestions or should I just ask the chiefs to switch my rotation? Thanks!

 

[Orin]

Congratulations! It feels like a lot of pregnancy annoucements this month!

http://www.advancesinanesthesia.com/article/S0737-6146(11)00007-4/pdf
Anesthetic Gases: Guidelines for Workplace Exposures | Occupational Safety and Health Administration
CDC - Reproductive Health - Anesthetic Gases - NIOSH Workplace Safety and Health Topic

There is a defined increase in risk for volatile exposure, and honestly many of the other agents used during OR cases like bone cement, but the I think most would tell you with modern safeguards the risks are very low. It's difficult though when it is your own fetus, so I think most of us would still opt to stay safer rather than roll the dice. Unfortunately anesthesia and healthcare in general comes with a lot of occupational exposures.

The simplest thing would be to switch with another resident if possible and if not, work to minimize inhalational inductions. I'm sure there are also many pediatric anesthesia fellows, attendings, CRNAs at your institute who could give you advice on how to do this. I would assume your pediatric anesthesia attendings would be as concerned if not more about this than you are, so I would ask them about ways to minimize exposure to sevoflurane.

You could also ask your hospital system's OSHA/employee health folks about any safe guards, but that's more of a PITA. I suspect though if they were to sample the OR or even the PACU air for volatiles, the concentrations would be higher at induction, extubation, PACU arrival than the usual limits.

In fact it looks like someone did that study too: Internet Scientific Publications

 

[deleted59964]

I'm a current CA2 and just found out that I'm pregnant. I have a peds rotation coming up when I would be in my third month of pregnancy. I'm a little concerned about all of the inhalational exposure. Anybody have any suggestions or should I just ask the chiefs to switch my rotation? Thanks!

use the circle system to do gas inductions.
if they're small kids - macgyver a scavenger to a T piece system

 

[deleted875186]

use the circle system to do gas inductions.
if they're small kids - macgyver a scavenger to a T piece system

We use circle systems all the time for any induction. I assume she is concerned about leaks around the mask, removing the mask for intubation, etc, not really exposures that can be minimized all that much more other than avoiding those cases altogether.

 

[aprilrain]

At my institution most attendings like the resident to flush the circuit with Sevo and/or nitrous while they put on monitors to make minimize patient discomfort (breathing in dead space air while a mask is held to your face), so there's quite a bit of exposure just from that.

 

[deleted87051]

Wear scuba

 

[michigangirl]

Peds Anesthesia attending here. I personally wouldn't ask to switch for some of the reasons already outlined, just let your attendings know that you won't be using nitrous when you discuss your plans and let whoever is doing scheduling know so they don't post you in rooms where you have to lead and possibly MRI. If it's easy enough to switch with another resident then great. Perfect your masking skills so that leaking is minimal to none even if the kids are squirming like all get out- it can be done.

 

[skankhunt42]

Your risk for CMV exposure is much higher in Peds and there is absolutely a downside to that as it is a teratogen. I would see if you have CMV IgG's (get it through your OB). If you are IgG negative, I'd avoid Peds like the plague. Or wash your hands obsesively!