Gastrointestinal endoscopy in pregnancy

Table 3 Safety of anesthetics commonly used in gastrointestinal endoscopy

Drug	FDA category in pregnancy	Key points about drug safety
Narcotics
Meperidine	B, but D at term	Repeated use of high dose and prolonged administration can cause respiratory depression and seizures
Fentanyl	C	It is safe in low doses
Propofol	B	Generally suggested for use in patients who are sedated with difficulty and in complicated clinical situations
General anesthetics
Ketamine	B	Data are limited with humans; animal data suggest prolonged use is not safe
Sedatives
Diazepam	D	Some congenital malformations and mental retardation may be associated with diazepam, the use of diazepam during pregnancy is restricted
Midazolam	D	As a benzodiazepine member, its use is restricted during pregnancy, especially in the first trimester
Reversing agents
Naloxone	B	It probably is safe but should be used only in respiratory depression, systemic hypotension, or unresponsiveness in a closely monitored pregnant woman after endoscopy
Flumazenil	C	Fetal risks are unknown, but it should be given carefully in small doses

FDA: United States Food and Drug Administration.