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Anesthesia · single question

Which anesthetic should be avoided during pregnancy?

  1. 2% Lidocaine with Epinephrine 1:100,000
  2. 4% Articaine
  3. 3% Mepivacaine
  4. 2% Lidocaine without Epinephrine
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Correct answer: C. 3% Mepivacaine

3% Mepivacaine (plain, without vasoconstrictor) is classified as FDA Category C in pregnancy and is generally avoided. More importantly, mepivacaine crosses the placenta and has a long half-life in the fetal circulation because neonates have reduced ability to metabolize it. Lidocaine (FDA Category B) is the drug of choice during pregnancy. Articaine is also considered relatively safe. Mepivacaine should be avoided during pregnancy.
  • A. INCORRECT. 2% Lidocaine with epinephrine is FDA Category B and is the preferred local anesthetic during pregnancy. Epinephrine at standard doses is also safe.
  • B. INCORRECT. 4% Articaine is considered relatively safe in pregnancy, though evidence is more limited than lidocaine.
  • C. CORRECT. 3% Mepivacaine is FDA Category C and is generally avoided in pregnancy. It crosses the placenta freely, and the neonatal liver cannot metabolize it efficiently, leading to drug accumulation. Additionally, mepivacaine causes uterine artery vasoconstriction.
  • D. INCORRECT. 2% Lidocaine without epinephrine is also Category B and safe in pregnancy.

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