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931: Advanced Principles of Anesthesia I > Anesthesia for gynecological surgery > Flashcards

Anesthesia for gynecological surgery Flashcards

1
Q

Describe what a D&C is.

A

Dilate cervix & curettage (scrape walls of) uterus to remove, often vacuum aspirate products of conception (1st trimester), cysts, or tumors

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2
Q

Anesthetic considerations for the patient undergoing a D&C include

A 
emotional state
baseline CBC
intraoperative Hgb/Hct monitoring 
analgesia/antiemetics/uterine relaxation
venous access x 1
volume status
availability of T&S (typically not needed for 1st trimester D & C)
positioning/lithotomy
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3
Q

A D&E is performed in

A

the 2nd trimester (between 12-24 weeks of pregnancy)

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4
Q

A dilation and evacuation is typically performed due to

A

miscarriage or elective pregnancy termination–> lots of psychosocial considerations

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5
Q

The anesthetic considerations for a D&E are

A 
relatively same approach & considerations as D&C
uses vacuum aspirator & forceps 
-might take a little longer
-increased risk of bleeding than D&C
-have drugs available
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6
Q

Uterotonic medications act

A

directly on uterine smooth muscle to increase tone, rate, & strength of rhythmic contractions

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7
Q

Oxytocin (Pitocin) is a

A

naturally produced hormone secreted by the posterior pituitary
uterotonic (stimulates uterine contractions, labor onset–> postpartum)

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8
Q

Benefits & uses of oxytocin include

A

prevent/treat postpartum hemorrhage (PPH)
ripen the cervix and induce labor
manage incomplete or elective abortion

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9
Q

Describe methergine

A

semi-synthetic ergot alkaloid
prevents & controls PPH
0.2 mg IM
avoid in patients with HTN

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10
Q

Pitocin is a

A

synthetic oxytocin & can be given IV or IM

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11
Q

What is Mifeprex?

A

synthetic steroid made from norethindrone

only non-surgical option for abortion during first 49 days of pregnancy

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12
Q

Describe hemabate.

A

prostaglandin
250 mcg IM
also used for elective abortion
AVOID with asthmatics

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13
Q

Describe Cervidil.

A

vaginal insert that causes cervical ripening
10 mg/insert
stimulates PGF-2a= sensitizes myometrium to oxytocin

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14
Q

Describe conization of the cervix.

A

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

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15
Q

Indications for conization of the cervix includes

A

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

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16
Q

Methods used for conization of the cervix include

A

scalpel (cold-knife)
laser (excision or vaporization)
electrosurgical excision loop (LEEP)
large loop excision of the transformation zone (LLETZ)
combination (laser & completed with a cold-knife)

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17
Q

Describe the route, onset of action, DOA, and side effects of oxytocin.

A

route: IM
onset: 2-3 minutes
DOA: 15-30 minutes
Side effects: minimal (N/V, cardiac arrhythmia, anaphylaxis)

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18
Q

Describe the route, onset of action, DOA, and side effects of misoprostol.

A

route: PO
onset of action 3 to 5 minutes
duration of action: 75 minutes
SE: shivering, diarrhea, transient temperature >38 degrees C

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19
Q

Describe the route, onset of action, DOA, & SE of ergometrine.

A

IM
onset: 6-7 minutes
DOA: 120-140 minutes
SE: increased BP (vasoconstriction), HA, dizziness, nausea, vomiting, tinnitus, rash

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20
Q

Describe the route, onset of action, DOA, & SE of syntometrine.

A

IM
onset: 2 to 3 minutes
duration: 120-240 minutes
SE: N/V, HA, dizziness, hypertension, arrhythmia, & rash

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21
Q

Hysteroscopy is when they

A

visualize inside the uterus to diagnose or treat uterine problems

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22
Q

Indications for hysteroscopy include

A

abnormal uterine bleeding, fibroids, polyps, cancer biopsies, remove adhesions, sterilization, locate intrauterine device (IUD)

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23
Q

The surgical procedure of hysteroscopy involves

A

emptying of the bladder (in & out catheter)
speculum into the vagina
hysteroscope advanced through vagina, cervix, and into the uterus
project images onto a screen
Gas (CO2) or fluid (NS or LR) expands uterus

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24
Q

Describe the risks involved with hysterosocopy

A

uterine or cervical puncture/perforation, bleeding, infection, hypervolemia, hyponatremic encephalopathy/cardiac asystole, arrhythmia, hypercarbia/acidosis/gas embolism

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25
Endometrial ablation is used to
treat heavy bleeding when medications are unsuccessful
26
Endometrial ablation involves
destroying the endometrium (thin lining of the uterus) to stop or reduce menstrual flow
27
Endometrial ablation is not performed
in post menopausal women
28
Endometrial ablation is not advised for the following conditions:
``` thin endometrium endometrial hyperplasia uterine cancer recent pregnancy current or recent uterine infection ```
29
Endometrial ablation risks include
bleeding, infection, uterine or bowel perforation, internal burns
30
Endometrial ablation surgical length is
30-60 minutes | no incisions are made
31
Colposcopy is typically an
office procedure but occasionally performed in the OR | used to view the cervix using colposcope magnified 2-60x
32
Colposcopy is used to assess
cervicitis, uterine polyps, pain, bleeding, & cervical warts
33
Tubal ligation is when the
fallopian tubes are pulled through navel, cut and closed (sutures, bands or clips)
34
Tubal ligation can be performed under
epidural, spinal, combine spinal-epidural, general anesthesia, or IV sedation with local anesthesia -can be performed post-Caesarian section & it does not extend hospital stay
35
Risks of tubal ligation include
bleeding & infection
36
Endometriosis is the
endometrial growth outside uterus (ovaries, bowel, bladder, rectum, pelvic wall, etc.) retrograde menstruation with suspected immune system explanation responds to hormonal changes
37
Endometriosis causes
pain, irregular bleeding, adhesions, and possibly infertility
38
Treatment options for endometriosis include
hormone therapy | surgical intervention-diagnostic laparoscopy, excision of endometrial tissue, hysterectomy, laparotomy
39
Ectopic pregnancy is when the
fertilized egg attaches outside of the uterus (most commonly in fallopian tubes)
40
The second leading cause of maternal mortality is
ectopic pregnancy
41
Symptoms of ectopic pregnancy include
vaginal bleeding, pelvic pain, dizziness, fainting, weakness, shoulder pain (rupture)
42
A rupture in ectopic pregnancy is
life-threatening (internal bleeding), may require salpingectomy
43
Ectopic pregnancy treatment includes
surgical excision of ectopic or medial management (methotrexate)
44
A hysterectomy is the
surgical removal of the uterus
45
The 2nd most common major surgery among women of childbearing age is
hysterectomy
46
A hysterectomy is the method of treatment for
``` uterine fibroids endometriosis uterine prolapse abnormal uterine bleeding chronic pelvic pain cancer ```
47
The approach for hysterectomy is dependent on
surgical intervention & patient health status
48
A subtotal hysterectomy involves removal of
the body of the uterus
49
A total hysterectomy involves removal of
body of uterus & cervix
50
A radical hysterectomy involves removal of
body of uterus, cervix, vagina, L& R parametrium
51
A laparoscopic hysterectomy can be performed via
total laparoscopic hysterectomy laparoscopically assisted vaginal hysterectomy robot- assisted laparoscopic hysterectomy
52
Describe total laparoscopic hysterectomy.
uterus detached, removed in pieces through incisions or passed through the vagina
53
Describe laparoscopically assisted vaginal hysterectomy
vaginal hysterectomy with laparoscopic assistance laparoscopic visualization & removal of organs removed through the vagina
54
Advantages of a laparoscopic hysterectomy include
smaller incisions, less pain, shorter hospital stay, shorter recovery, less risk of infection & other postoperative complications
55
Disadvantages of laparoscopic hysterectomy include
increased surgical time increased risk for bladder injury risks associated with pneumoperitoneum
56
Describe a radical hysterectomy
removes uterus, cervix, ovaries, fallopian tubes, upper vagina, parametrium, & pelvic lymph nodes
57
Indications for a radical hysterectomy include
uterine, cervical or ovarian cancer endometriosis fibroids pelvic relaxation syndrome
58
Describe the surgical time, incisions, and EBL for radical hysterectomy
surgery time: 3-4 hours incision: midline or low transverse EBL: 1500 mL need T&S, 2 large bore IVs and be prepared to administer blood products
59
Postoperative considerations for the patient with hysterectomy include
earlier risk for osteoporosis then menopausal women | treated with estrogen therapy-symptomatology determines treatment form
60
Oopherectomy effects caused by lack of estrogen include
hot flashes, vaginal dryness, sleep problems
61
Preoperative treatments for myomectomy include
multivitamins, iron supplements, gonadotropin releasing hormone agonist, oral contraceptives
62
Anesthetic considerations for myomectomy includes
``` T&C intraoperative hemoglobin/Hct monitoring IV fluid & blanket warming equipment third space fluid loss w/ open approach surgical approach determined by type of fibroids (hysteroscopic, abdominal, laparoscopic, robotic) general or regional anesthetic prophylactic antithrombotic therapy ```
63
A second look laparotomy is used for
diagnositic purposes
64
A second look laparotomy is the most accurate method of
assessing disease status in ovarian cancer
65
Second look laparotomy evalutes
effectiveness of treatment, size of tumor after treatment, & recurrence of tumor
66
Negative second look laparotomy is associated with
improved survival | has same anesthetic considerations as staging laparotomy
67
Anesthetic considerations for the radical vulvectomy includes
chemotherapeutics bowel preparation general, spinal, or epidural anesthesia PCA or epidural for postoperative pain management foley catheter high risk for infection Modified dorsal lithotomy- potential for nerve injury
68
Antiemetics to consider for PONV include
``` ondansetron 4 mg reglan 10 mg IV dexamethasone 4-8 mg IV propofol diphenhydramine 10-50 mg IV or IM phenegran 0.25-1 mg/kg granisetron 10-40 mcg/kg scopolamine patch 1.5 mg euvolemia ```
69
Pelvic exenteration is the
removal of all organs from pelvis
70
Indication for pelvic exenteration is
advanced or recurrent pelvic cancer
71
Morbidity & mortality with pelvic exenteration is
3-5% death intraoperatively; 5 year survival=60%
72
Pelvic exenteration involves the removal of
radical hysterectomy, total vaginectomy, bladder excision (urostomy), urinary diversion, bowel resection + colostomy (anterior=bladder removed, posterior=rectum removed) neovagina construction available
73
Surgical risks of pelvic exenteration includes
hemorrhage (internal & common iliac arteries), sepsis, wound dehiscence, anastomotic breakdown at bowel, urinary pouch or ureteral sites, DVT, PE, stoma necrosis or reconstructive flap necrosis
74
Late complications of pelvic exenteration includes
fistula, bowel obstruction, ureteral stricture, renal failure, pyelonephritis, & chronic bowel obstructions
75
Positioning concerns with lithotomy includes
patient supine, legs flexed/abducted, feet at or above hip level access to perineum (table edge) prolonged lithotomy position associated with compartment syndrome femoral or peroneal nerve injury autotransfusion- transient hemodynamic changes caution with PVD patients simultaneous leg lift & hip flexion to avoid dislocation
76
With the combine lithotomy and Trendelenburg position we will see
Increased CVP & PAP CO decreased caution in patients with CAD

931: Advanced Principles of Anesthesia I (22 decks)

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