Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

N931 Advanced Principles of Anesthesia I > Anesthesia for GYN Surgery > Flashcards

Anesthesia for GYN Surgery Flashcards

1
Q

dilation and curettage (D&C)

A
  • dilate cervix and curettage (scrape walls of) uterus to remove (or vacuum aspirate) products of conception, cysts or tumors
  • POC only in 1st trimester
  • sometimes have suction
  • US on at same time to ensure all POC are removed (if not then could have bleeding)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

anesthetic considerations D&C

A
  • emotional state
  • baseline CBC
  • intraop H/H monitoring
  • analgesia
  • antiemetics
  • uterine relaxation
  • venous access
  • volume
  • have T&S
  • position = lithotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

dilation and evacuation (D&E)

A
  • performed in 2nd trimester between 12-24 weeks of pregnancy
  • miscarriage or elective pregnancy termination
  • relatively same approach and considerations as D&C
  • vacuum aspirator and forceps
  • increased risk of bleeding compared to D&C
  • have uterotonics on hand - pitocin, methergine, hemabate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

uterotonic medications

A
  • act directly on uterine smooth muscle

- increase tone, rate, and strength of rhythmic contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

oxytocin (pitocin)

A
  • naturally produced hormone
  • secreted by the pituitary
  • uterotonic, stimulates uterine contractions, labor onset –> postpartum
  • 10-20 unit vial (dilute)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

benefits of uterotonics

A
  • prevent/treate PPH
  • ripen cervix and induce labor
  • manage incomplete or elective abortion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

mifeprex (mifepristone)

A
  • medical management of abortion at home if within 49 days and pass at home
  • may come in for retained POC
  • synthetic steroid made from norethindrone (active ingredient of norplant)
  • only FDA approved non-surgical option for abortion during first 49 days of pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

methergine

A
  • semi-synthetic ergot alkaloid
  • prevents and controls PPH
  • 0.2 mg IM (ONLY IM)
  • contraindication - HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

hemabate (carboprost tromethamine)

A
  • prostaglandin F2a
  • 250 mcg (0.25 mg) IM
  • IM ONLYYYY
  • also used for elective abortion
  • avoid with asthmatics –> can cause severe RAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

cervidil (dinoprostone), prepidil, prostin E2

A
  • vaginal insert
  • naturally occuring biomolecule (PGE2)
  • stimulates PGF-2a (which sensitizes myometrium to oxytocin)
  • cervical ripening + induce labor in that way
  • 10 mg/insert
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

conization of cervix

A

excision of cylindrical (cone-shaped) wedge from the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

indications for conization of cervix

A
  • definitive diagnosis of squamous or glandular intraepithelial lesions
  • excluding microinvasive carcinomas
  • conservative treatment of cervical intra-epithelial neoplasia (CIN)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

methods for conization of cervix

A
  • scalpel (cold-knife)
  • laser (excision or vaporization)
  • electrosurgical excision loop (LEEP)
  • large loop excision of the transformation zone (LLETZ)
  • combination (laser and completed with a cold-knife)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

hysteroscopy

A

-visualization inside uterus to diagnose or treat uterine problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

hysteroscopy indications

A
  • abnormal uterine bleeding
  • fibroids
  • polyps
  • cancer
  • biopsies
  • remove adhesions
  • sterilization
  • locate IUD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

hysteroscopy surgical procedure

A
  • empty bladder (in and out cath)
  • speculum into the vagina
  • hysteroscope advanced through vagina, cervix and into uterus
  • project image onto screen
  • gas (CO2) or fluid (NS or LR) expands uterus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

hysteroscopy risks

A
  • uterine or cervical puncture/perf
  • bleeding
  • infection
  • hypervolemia
  • hyponatremic ecephalopathy
  • cardiac asystole
  • arrhythmia
  • hypercarbia/acidosis/gas embolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

endometrial ablation

A
  • treats heavy bleeding when medications unsuccessful (endometriosis)
  • destroys endometrium
  • stops or reduces menstrual flow
  • not performed in post menopausal women
  • no incisions
  • surgical time - 30-60 min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

endometrial ablation not advised for the following

A
  • thin endometrium
  • endometrial hyperplasia
  • uterine cancer
  • recent pregnancy
  • current or recent uterine infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

endometrial ablation risks

A
  • bleeding
  • infection
  • uterine or bowel perf
  • internal burns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

colposcopy

A
  • typically office procedure; occasionally in OR

- view office in colposcope magnified 2-60x

22
Q

colposcopy used to assess what?

A
  • cervicitis
  • uterine polyps
  • pain
  • bleeding
  • cervical warts
23
Q

tubal ligation

A
  • fallopian tubes pulled through navel, cut and closed (sutures, bands, clips)
  • performed post c-section; does not extend stay
24
Q

tubal ligation anesthesia

A
  • epidural
  • spinal
  • combined spinal-epidural
  • GA
  • IV sedation with LA
25
Q

tubal ligation surgical time

A

30 min

26
Q

tubal ligation risks

A
  • bleeding

- infection

27
Q

endometriosis

A
  • endometrial growth outside uterus (ovaries, bowel, bladder, rectum, pelvic wall)
  • responds to hormonal changes
  • retrograde menstruation with suspected immune system explanation
  • causes pain, irregular bleeding, adhesions, possible infertility
28
Q

endometriosis treatment options

A
  • hormone therapy

- surgical intervention - diagnostic lap, excision of endometrial tissue/ablation, hysterectomy, laparotomy

29
Q

ectopic pregnancy

A
  • fertilized egg attached outside of uterus (most commonly in fallopian tubes)
  • second leading cause of maternal mortality
  • rupture is life-threatening, may require salpingoectomy
  • surgical excision of ectopic or medical management
30
Q

ectopic pregnancy symptoms

A
  • vaginal bleeding
  • pelvic pain
  • dizziness
  • fainting
  • weakness
  • shoulder pain (rupture)
31
Q

hysterectomy

A
  • surgical removal of the uterus
  • 2nd most common major surgery among women of childbearing age
  • approach depends on reason for the surgical intervention and patient health status
32
Q

hysterectomy is treatment for what?

A
  • uterine fibroids
  • endometriosis
  • uterine prolapse
  • abnormal uterine bleeding
  • chronic pelvic pain
  • cancer
33
Q

three types of laparoscopic hysterectomy

A
  • total laparoscopic hysterectomy
  • laparoscopically assisted vaginal hysterectomy (LAVH)
  • robot-assisted laparoscopic hysterectomy
34
Q

laparoscopic hysterectomy advantages

A
  • smaller incisions
  • less pain
  • shorter hospital stay
  • shorter recovery
  • less risk of infection and other post-op complications
35
Q

laparoscopic hysterectomy disadvantages

A
  • increased surgical time
  • increased risk for bladder injury
  • risks associated with pneumoperitoneum
36
Q

radical hysterectomy

A

-removes uterus, cervix, ovaries, fallopian tubes, upper vagina, parametrium, pelvic lymph nodes

37
Q

radical hysterectomy indications

A
  • uterine, cervical or ovarian cancer
  • endometriosis
  • fibroids
  • pelvic relaxation syndrome
38
Q

radical hysterectomy surgical time

A

3-4 hours

39
Q

radical hysterectomy incision

A

midline or low transverse

40
Q

radical hysterectomy EBL

A

1500 mL

41
Q

postoperative considerations for hysterectomy

A
  • oophrectomy effects caused by lack of estrogen (hot flashes, vaginal dryness, sleep problems)
  • earlier risk for osteoporosis than menopausal women
  • positioning considerations
  • treated with estrogen therapy (pill, injection, skin patch, vaginal cream, vaginal ring)
42
Q

myomectomy

A

surgical procedure to remove uterine fibroids

43
Q

myomectomy preop treatments

A
  • multivitamins
  • iron supplements
  • gonadotropin releasing hormone agonist
  • oral contraceptives
44
Q

myomectomy anesthetic considerations

A
  • type and corss
  • intraop H&H
  • IV fluid and blanket warming equipment
  • third space fluid loss (open approach)
  • surgical approach determine by type of fibroids
  • general or regional
  • prophylactic antithrombotics
45
Q

second look laparotomy (SLL)

A
  • diagnostic
  • most accurate method of assessing disease status in ovarian cancer
  • patients completed initial therapy, clinical free of disease
  • negative SLL associated with improved survival
  • same anesthetic considerations as staging laparotomy
46
Q

anesthetic considerations for radical vulvectomy

A
  • chemo
  • bowel prep
  • general, spinal, epidural
  • PCA or epidural post op pain
  • foley
47
Q

modified dorsal lithotomy

A
  • position used for radical vulvectomy
  • legs extended
  • hips abducted 30 degrees
  • extended 5-10 degrees
  • knees flexed 90 degrees
  • potential for nerve injury
48
Q

pelvic exenteration or evisceration

A
  • remove all organs from pelvis
  • indicated for advanced or recurrent pelvic cancer
  • radical hysterectomy, total vaginectomy, bladder excision (urostomy), urinary diversion, bowel resection (colostomy)
  • neovagina construction available
49
Q

pelvic exenteration M&M

A
  • 3-5% death intraop

- 5 year survival = 10%

50
Q

surgical risks of pelvic exenteration

A
  • hemorrhage
  • sepsis
  • wound dehiscence
  • anastomotic breakdown at bowel
  • urinary pouch
  • ureteral sites
  • DVT/PE
  • stoma necrosis
  • reconstructive flap necrosis
51
Q

late complications of pelvic exenteration

A
  • 33% of people experience
  • fistula
  • bowel obstruction
  • ureteral stricture
  • renal failure
  • pyelonephritis
  • chronic bowel obstruction
  • increased risk renal disease post op due to UTI and obstruction

N931 Advanced Principles of Anesthesia I (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions