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dental treatment. Such false information and consequential delays in treatment can result in a dental emergency that may lead to hospitalization, intubation, and/or general anesthesia, all of which may have been preventable. As essential dental treatment and regular oral examinations are ideal for maintaining the health of the parturient and developing infant, dental providers should possess a robust understanding of the physiologic adaptations that affect various organ systems during pregnancy. Furthermore, providers treating a parturient who requires advanced

toxicity from xenobiotics. This increased risk of fetotoxicity is largely attributed to the immaturity of the mechanisms and structure of the maternal-fetal circulatory exchange. 1 The barrier function provided by the placenta forms the core of the regulatory and filtration capabilities, affecting medications administered to or consumed by the parturient. Transport Across the Placental Barrier Placental exchange is a dynamic circulatory process throughout pregnancy. The determinants of drug transfer are influenced by the structural components

age 20 years and more than 80% by age 40 years. 10 – 12 There is no clear recommendation for either general or regional anesthesia for patients with EDS. 13 In patients with tissue fragility, epidural or spinal anesthesia would induce hematoma formation or bleeding by needle insertion and catheterization. 13 , 14 In obstetric operations, regional versus general anesthesia is chosen based on risk-benefit assessment. 14 There is no agreement on optimal delivery method, vaginal delivery or cesarean delivery, 13 and the mortality rates in the parturient with EDS

maximum recommended doses of local anesthetics in many of their major conduction nerve blocks, particularly in obstetric anesthesia for epidural analgesia and anesthesia in parturients who have a lower threshold for local anesthetic toxicity. Although this drug would likely have little use in most dental offices, dentists with training in intravenous techniques who use large doses of local anesthetics for complex and prolonged procedures may be wise to stock this drug. Additionally, it may become a standard drug for emergency room physicians who might ultimately treat

, Yentis SM. General anaesthesia for Caesarean section in a parturient with Noonan's syndrome . Br J Anaesth . 1996 ; 77 : 665 – 668 . 7 Nakamura S , Takada K , Nishiyama T , et al . General anesthesia for a patient with Noonan's syndrome and long-term antidepressant therapy [in Japanese] . Masui

. Delirium: Acute Confusional States . New York, NY Oxford University Press . 1990 . 38 . 11 Weinger , M. B. , N. R. Swerdlow , and W. L. Millar . Acute postoperative delirium and extrapyramidal signs in a previously healthy parturient. Anesth Analg 1988 . 67 : 291 – 295 .

syndrome . Pediatrics . 2014 ; 133 : e1299 – e1304 . 15.  Grange CS, Heid R, Lucas SB, Ross PL, Douglas MJ. Anaesthesia in a parturient with Noonan's syndrome . Can

, Castello-Cortes A, Robinson PN. Lithium toxicity and the parturient: case report and literature review . Int J Obstet Anesth . 2008 ; 17 : 164 – 169 . 2.  Leone CW. Anesthetic management of lithium-treated patients . Anesth Prog . 1984 ; 31 : 138 – 140 . 3

. DPSGC has not been studied in parturients and is thus not recommended in that patient population. Additionally, the presence or amount of DPSGC in human milk has not been studied; nursing while taking DPSGC is not recommended. 20 There is insufficient data regarding DPSGC in patients 65 years of age and older; it is not possible to conclude that this patient population will respond differently to DPSGC when compared to younger patients. Elderly patients often have reduced renal function and increased risk for gastrointestinal bleeding. Elderly patients also