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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
Q

Endometrial ablation is used to

A

treat heavy bleeding when medications are unsuccessful

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26
Q

Endometrial ablation involves

A

destroying the endometrium (thin lining of the uterus) to stop or reduce menstrual flow

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27
Q

Endometrial ablation is not performed

A

in post menopausal women

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28
Q

Endometrial ablation is not advised for the following conditions:

A 
thin endometrium
endometrial hyperplasia
uterine cancer
recent pregnancy
current or recent uterine infection
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29
Q

Endometrial ablation risks include

A

bleeding, infection, uterine or bowel perforation, internal burns

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30
Q

Endometrial ablation surgical length is

A

30-60 minutes

no incisions are made

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31
Q

Colposcopy is typically an

A

office procedure but occasionally performed in the OR

used to view the cervix using colposcope magnified 2-60x

32
Q

Colposcopy is used to assess

A

cervicitis, uterine polyps, pain, bleeding, & cervical warts

33
Q

Tubal ligation is when the

A

fallopian tubes are pulled through navel, cut and closed (sutures, bands or clips)

34
Q

Tubal ligation can be performed under

A

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
Q

Risks of tubal ligation include

A

bleeding & infection

36
Q

Endometriosis is the

A

endometrial growth outside uterus (ovaries, bowel, bladder, rectum, pelvic wall, etc.)
retrograde menstruation with suspected immune system explanation
responds to hormonal changes

37
Q

Endometriosis causes

A

pain, irregular bleeding, adhesions, and possibly infertility

38
Q

Treatment options for endometriosis include

A

hormone therapy

surgical intervention-diagnostic laparoscopy, excision of endometrial tissue, hysterectomy, laparotomy

39
Q

Ectopic pregnancy is when the

A

fertilized egg attaches outside of the uterus (most commonly in fallopian tubes)

40
Q

The second leading cause of maternal mortality is

A

ectopic pregnancy

41
Q

Symptoms of ectopic pregnancy include

A

vaginal bleeding, pelvic pain, dizziness, fainting, weakness, shoulder pain (rupture)

42
Q

A rupture in ectopic pregnancy is

A

life-threatening (internal bleeding), may require salpingectomy

43
Q

Ectopic pregnancy treatment includes

A

surgical excision of ectopic or medial management (methotrexate)

44
Q

A hysterectomy is the

A

surgical removal of the uterus

45
Q

The 2nd most common major surgery among women of childbearing age is

A

hysterectomy

46
Q

A hysterectomy is the method of treatment for

A 
uterine fibroids
endometriosis
uterine prolapse
abnormal uterine bleeding
chronic pelvic pain
cancer
47
Q

The approach for hysterectomy is dependent on

A

surgical intervention & patient health status

48
Q

A subtotal hysterectomy involves removal of

A

the body of the uterus

49
Q

A total hysterectomy involves removal of

A

body of uterus & cervix

50
Q

A radical hysterectomy involves removal of

A

body of uterus, cervix, vagina, L& R parametrium

51
Q

A laparoscopic hysterectomy can be performed via

A

total laparoscopic hysterectomy
laparoscopically assisted vaginal hysterectomy
robot- assisted laparoscopic hysterectomy

52
Q

Describe total laparoscopic hysterectomy.

A

uterus detached, removed in pieces through incisions or passed through the vagina

53
Q

Describe laparoscopically assisted vaginal hysterectomy

A

vaginal hysterectomy with laparoscopic assistance laparoscopic visualization & removal of organs removed through the vagina

54
Q

Advantages of a laparoscopic hysterectomy include

A

smaller incisions, less pain, shorter hospital stay, shorter recovery, less risk of infection & other postoperative complications

55
Q

Disadvantages of laparoscopic hysterectomy include

A

increased surgical time
increased risk for bladder injury
risks associated with pneumoperitoneum

56
Q

Describe a radical hysterectomy

A

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

57
Q

Indications for a radical hysterectomy include

A

uterine, cervical or ovarian cancer
endometriosis
fibroids
pelvic relaxation syndrome

58
Q

Describe the surgical time, incisions, and EBL for radical hysterectomy

A

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
Q

Postoperative considerations for the patient with hysterectomy include

A

earlier risk for osteoporosis then menopausal women

treated with estrogen therapy-symptomatology determines treatment form

60
Q

Oopherectomy effects caused by lack of estrogen include

A

hot flashes, vaginal dryness, sleep problems

61
Q

Preoperative treatments for myomectomy include

A

multivitamins, iron supplements, gonadotropin releasing hormone agonist, oral contraceptives

62
Q

Anesthetic considerations for myomectomy includes

A 
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
Q

A second look laparotomy is used for

A

diagnositic purposes

64
Q

A second look laparotomy is the most accurate method of

A

assessing disease status in ovarian cancer

65
Q

Second look laparotomy evalutes

A

effectiveness of treatment, size of tumor after treatment, & recurrence of tumor

66
Q

Negative second look laparotomy is associated with

A

improved survival

has same anesthetic considerations as staging laparotomy

67
Q

Anesthetic considerations for the radical vulvectomy includes

A

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
Q

Antiemetics to consider for PONV include

A 
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
Q

Pelvic exenteration is the

A

removal of all organs from pelvis

70
Q

Indication for pelvic exenteration is

A

advanced or recurrent pelvic cancer

71
Q

Morbidity & mortality with pelvic exenteration is

A

3-5% death intraoperatively; 5 year survival=60%

72
Q

Pelvic exenteration involves the removal of

A

radical hysterectomy, total vaginectomy, bladder excision (urostomy), urinary diversion, bowel resection + colostomy (anterior=bladder removed, posterior=rectum removed)
neovagina construction available

73
Q

Surgical risks of pelvic exenteration includes

A

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
Q

Late complications of pelvic exenteration includes

A

fistula, bowel obstruction, ureteral stricture, renal failure, pyelonephritis, & chronic bowel obstructions

75
Q

Positioning concerns with lithotomy includes

A

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
Q

With the combine lithotomy and Trendelenburg position we will see

A

Increased CVP & PAP
CO decreased
caution in patients with CAD

931: Advanced Principles of Anesthesia I (22 decks)

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