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N931 Advanced Principles of Anesthesia I > anesthesia for GYN surgery > Flashcards

anesthesia for GYN surgery Flashcards

1
Q

D&C

A

dilate cervix and curettage (scrape walls of) uterus to remove and/or vacuum aspirate products of conception (1st trimester), cysts, or tumors

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2
Q

anesthetic considerations for D&C

A

pt’s emotional state, baseline CBC, intraop H/H, analgesia/antiemetics/uterine relaxation, venous access, volume status, availability of T&S, positioning/lithotomy

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3
Q

what is common in patients needing D&C that is fixed by having the procedure?

A

anemia

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4
Q

if any products of conception are retained what are patients at risk for?

A

bleeding

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5
Q

D&E

A

dilation and evacuation performed in 2nd trimester (between 12-24 weeks), can be for miscarriage or elective pregnancy termination, typically need to use vacuum and/or forceps

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6
Q

what kind of agents would you want on hand for a D&C or D&E?

A

uterotonic agents

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7
Q

uterotonic medications MOA

A

act directly on uterine smooth muscle

increase tone, rate, and strength of rhythmic contractions

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8
Q

Oxytocin (Pitocin)

A

naturally produced hormone
secreted by the posterior pituitary
uterotonic - stimulates uterine contractions

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9
Q

benefits/uses for uterotonics

A

prevent/treat postpartum hemorrhage
ripen cervix and induce labor
manage incomplete or elective abortion

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10
Q

how do you prepare oxytocin

A

dilute, either 10units or 20units/mL vials, give 2 units IV and put the rest in 1 L bag of LR

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11
Q

Synthetic oxytocin (pitocin or syntocinon) can be given

A

given IV or IM but usually IV diluted

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12
Q

Mifeprex is a

A

synthetic steroid made from norethindrone (active ingredient of norplant)
only FDA approved non surgical option for abortion during first 49 days of pregnancy

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13
Q

Methergine (methylergonovine)

A

semi-synthetic ergot alkaloid
prevents and controls PPH
0.2 mg IM (can repeat)

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14
Q

when is Methergine contraindicated?

A

HTN, gestational HTN, eclampsia, pre-eclampsia

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15
Q

Hemabate (Carboprost tromethamine)

A

prostaglandin F2a

250 mcg IM (can only be given IM)

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16
Q

What kind of patients do you avoid Hemabate in?

A

asthmatics!

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17
Q

Cervidil (Dinoprostone), Prepidil, Prostin E2

A

inserted vaginally (10mg)
naturally occurring biomolecule (PGE2)
stimulates PGF-2a = sensitizes myometrium to oxytocin
causes cervical ripening for labor

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18
Q

Oxytocin IM

onset, duration, and side effects

A

Onset- 2-3 mins
DOA - 15-30 mins
SE - NV, cardiac arrhythmia, anaphylaxis

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19
Q

Misoprostol PO

onset, duration, side effects

A

onset- 3-5 minutes
DOA - 75, peak 18-34
SE - shivering, diarrhea, transient temp >38 degrees C

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20
Q

Ergometrine IM

onset, duration, side effects

A

Onset - 6-7 mins
DOA - 120-240 minutes
SE - increased BP, HA, dizziness, NV, tinnitus, rash

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21
Q

Syntometrine IM

onset, duration, side effects

A

Onset- 2-3 mins
DOA - 120-240 mins
SE - NV, HA, dizziness, HTN, arrhythmia, rash

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22
Q

Conization of the cervix

A

excision of a cylindrical wedge from the cervix

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23
Q

indications for a conization of the cervix

A

definitive diagnosis of squamous or glandular intra-epithelial lesions
excluding microinvasive carcinomas
conservative treatment of cervical intra-epithelial neoplasia (CIN)

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24
Q

different methods for conization of the cervix

A

scalpel, laser, electrosurgical excision loop (LEEP), large loop excision of the transformation zone (LLETZ), combo of laser and scalpel

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25
hysteroscopy
visualization inside the uterus to diagnose or treat uterine problems
26
indications for hysteroscopy
abnormal uterine bleeding, fibroids, polyps, cancer, biopsies, remove adhesions, sterilization, locate IUD
27
surgical procedure of hysteroscopy
empty bladder (straight cath), speculum into vagina then hysteroscope is advanced through vagina, cervix, and into uterus, images projected on screen and gas or fluid is injected to expand the uterus to help visualize
28
risks associated with hysteroscopy
uterine or cervical puncture/perforation, bleeding, infection, hypervolemia, hyponatremic encephalopathy/cardiac asystole, arrhythmia, hypercarbia/acidosis/gas embolism
29
why is it important to monitor fluids during a hysteroscopy?
instilled a lot of fluid into uterus that can get absorbed and cause hypervolemia, hyponatremia, brain swelling, metabolic acidosis
30
endometrial ablation treats
``` heavy bleeding (>2 pads/day) when medications are unsuccessful destroys the endometrium and stops or reduces menstrual flow ```
31
endometrial ablation is not advised for:
``` post menopausal women thin endometriums endometrial hyperplasia uterine cancer recent pregnancy current or recent uterine infection ```
32
surgical time for endometrial ablation
30-60 minutes, no incision is made
33
risks associated with endometrial ablation
bleeding, infection, uterine or bowel perforation, internal burns
34
colposcopy
typically done in the office | views the cervix using a colposcope magnified 2-60x
35
colposcopy is used to assess
cervicitis, uterine polyps, pain, bleeding, cervical warts (HPV), carcinoma
36
tubal ligation
the fallopian tubes are pulled through the naval and cut and closed with sutures, bands, or clips
37
surgical time for tubal ligation and what other procedure is it often paired with?
30 minutes , post-caesarian section
38
risks associated with tubal ligation
bleeding and infection
39
if the fallopian tubes are "banded" what can happen?
can still have an ectopic pregnancy | can be reversed
40
endometriosis is
endometrial growth outside of the uterus (ovaries, bowel, bladder, rectum, pelvic wall) that responds to hormonal changes retrograde menstruation with suspected immune system explanation
41
endometriosis causes
pain, irregular bleeding, adhesions, and possibly infertility
42
treatment options for endometriosis
``` hormone therapy diagnostic laparoscopy excision of endometrial tissue hysterectomy laparotomy ```
43
ectopic pregnancy is when
a fertilized egg is attached outside of the uterus (usually in fallopian tubes)
44
ectopic pregnancy is the ___ leading cause of maternal mortality
2nd, 15% of maternal deaths
45
symptoms of ectopic pregnancy
vaginal bleeding, pelvic pain, dizziness, fainting, weakness, shoulder pain (rupture)
46
ruptured ectopic pregnancy
LIFE THREATENING | have internal bleeding and may need to have salpingectomy
47
medical management of ectopic pregnancy
Methotrexate
48
hysterectomy
surgical removal of uterus
49
hysterectomy is the ___ most common major surgery among women of childbearing age
2nd
50
hysterectomy is used for treatment of
uterine fibroids, endometriosis, uterine prolapse, abnormal uterine bleeding, chronic pelvic pain, cancer
51
subtotal hysterectomy
body of the uterus
52
total hysterectomy
body of uterus + cervix
53
radical hysterectomy
body of uterus + cervix + parametrium + part of the vagina
54
if the ovaries are not removed with hysterectomy then the patient won't
go into early menopause
55
3 types of laparoscopic hysterectomy
1. total 2. laparoscopically assisted vaginal 3. robot assisted
56
total laparoscopic hysterectomy
uterus is detached, removed in pieces through the incisions or passed through the vagina
57
laparoscopically assisted vaginal hysterectomy (LAVH)
vaginal hysterectomy with laparoscopic assistance with visualization and removal of organs through the vagina
58
advantages of laparoscopic hysterectomy
smaller incisions, less pain, shorter hospital stay, shorter recovery, less risk of infection
59
disadvantages of laparoscopic hysterectomy
increased surgical time, increased risk for bladder injury, risks associated with pneumoperitoneum
60
radical hysterectomy removes
removes uterus, cervix, ovaries, fallopian tubes, upper vagina, parametrium, pelvic lymph nodes
61
indications for a radical hysterectomy
uterine, cervical or ovarian cancer endometriosis fibroids pelvic relaxation syndrome
62
surgical time of radical hysterectomy
3-4 hours
63
incision and EBL for radical hysterectomy
midline or low transverse | EBL 1500 mL
64
postop considerations for hysterectomy
earlier risk for osteoporosis than menopausal women | treated with estrogen therapy
65
oophorectomy effects with hysterectomy caused by
lack of estrogen (hot flashes, vaginal dryness, sleep problems)
66
myomectomy preop treatments
multivitamins, iron supplements, gonadotropin releasing hormone agonist, oral contraceptives
67
anesthetic considerations for myomectomy
T&C, intraop H/H, IV fluid and blanket warmer, third space fluid loss with open approach, can use general or regional, prophylactic antithrombotic therapy
68
second look laparotomy (SLL)
diagnostic most accurate method of assessing disease status in ovarian cancer should be clinically free of the disease because they already completed treatments
69
second look laparotomy evaluates
effectiveness of treatment, size of a tumor after treatment, and recurrence of tumor
70
radical vulvecotmy anesthetic considerations
given bowel prep, may be getting chemo, in modified dorsal lithotomy
71
modified dorsal lithotomy
``` legs extended hips abducted 30 degrees extended 5-10 degrees knees flexed 90 degrees potential for nerve injury.. shocker ```
72
pelvic exenteration or evisceration (remove all organs from pelvis) indication
advanced or recurrent pelvic cancer
73
5 year survival for pelvic exenteration
60%
74
pelvic exenteration or evisceration procedure
radical hysterectomy, total vaginectomy, bladder excision, urinary diversion, bowel resection and colostomy
75
surgical risks with pelvic exenteration or evisceration
hemorrage (internal and common iliac arteries), sepsis, wound dehiscence, anastomotic breakdown of bowel, urinary pouch, or ureteral sites, DVT, PE, stoma necrosis or reconstructive flap necrosis increased incidence of renal disease postop d/t UTI and obstruction
76
late complications of pelvic exenteration or evisceration
fistula, bowel obstruction, ureteral stricture, renal failure, pyelonephritis, chronic bowel obstructions
77
antiemetics to consider for PONV
ondansetron, reglan, dexamethasone, propofol, diphenhydramine, phenergan, granisetron, scopolamine, euvolemia, amend
78
cyclizine class, dose, side effects
class : histamine 1 receptor antagonist dose: 50 mg SE: sedation, dry mouth, blurred vision, HoTN, tachycardia
79
Ondansetron class, dose, side effects
class: 5HT3 receptor antagonists dose: 4 mg, 0.1mg/kg SE: dizziness, HA
80
Dexamethasone class, dose, side effects
class: corticosteroid dose: 4-8 mg IV, 0.2 mg/kg SE: flushing, perineal itch, hyperglycemia, infection, peptic ulcer, psychosis
81
hyoscine class, dose, side effects
class: muscarinic receptor antagonist dose: 1.5 mg patch SE: dry mouth, blurred vision, sedation
82
Metoclopramide class, dose, side effects
class: dopamine D2 dose: 10 mg IV, 0.25 mg/kg SE: abdominal cramping, restlessness, exrtapyramidal effects, sedation, hypotension
83
promethazine class, dose, side effects
class: phenothiazines dose: 12.5-25 mg SE: sedation
84
dronabinol class, dose, side effects
class: cannabinoid receptor antagonist dose: variable SE: euphoria, tachycardia, conjunctival congestion
85
lithotomy position concerns
prolonged = concern for compartment syndrome femoral or peroneal nerve injury autotransfusion caution with PVD patients
86
combined lithotomy and trendelenberg
CVP, PAP = increased CO = decreased caution with CAD patients

N931 Advanced Principles of Anesthesia I (6 decks)

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