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N931 Advanced Principles > Anesthesia for Gynecological Surgery > Flashcards

Anesthesia for Gynecological Surgery Flashcards

1
Q

What is a dilation and curettage?

A

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

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2
Q

What are anesthetic considerations for D&Cs?

A 
emotional state
venous access
baseline CBC
volume status
intraoperative H&H monitoring
availability of type and screen
analgesia/antiemetics/ uterine relaxation
positioning/lithotomy
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3
Q

What is a dilation and evacuation?

A

performed in 2nd trimester (between 12-24 weeks of pregnancy)
miscarriage or elective pregnancy termination

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4
Q

What is required with dilation and evacuation?

A

vacuum aspirate and forceps

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5
Q

Purpose of uterotonic medications?

A

acts directly on uterine smooth muscle

increase tone, rate and strength of rhythmic contractiosn

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6
Q

Oxytocin (Pitocin)

A

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

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7
Q

What are benefits/uses for oxytocin/ uterotonic medications?

A

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

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8
Q

Hemabate

A

carboprost tromethamine

prostaglandin F2a

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9
Q

What is the dose and route of hemabate?

A

250mcg IM

intramuscular injection only

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10
Q

What is hemabate used for?

A

elective abortions

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11
Q

When should hemabate be avoided?

A

asthmatics

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12
Q

Cervidil (dinoprostone)
prepidil
prostin E2

A 
vaginal insert
naturally occurring biomolecule (PGE2)
stimulates PGF-2a= sensitized myometrium to oxytocin
cervical ripening
10mg/insert
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13
Q

What is the route of oxytocin?

A

IM

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14
Q

What is the route of misoprostol?

A

PO

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15
Q

What is the route of ergometrine?

A

IM

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16
Q

What is the route of syntometrine?

A

IM

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17
Q

What is the onset of action of oxytocin?

A

2-3 minutes

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18
Q

What is the onset of action of misoprostol?

A

3-5 minutes

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19
Q

What is the onset of action of ergometrine?

A

6-7 minutes

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20
Q

What is the onset of action of syntometrine?

A

2-3 minutes

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21
Q

What is the DOA of oxytocin?

A

15-30 minutes

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22
Q

What is the DOA of misoprostol?

A

75 minutes (peak 8-34)

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23
Q

What is the DOA of of ergometrine?

A

120-240

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24
Q

What is the DOA of syntometrine?

A

120-240

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25
Q

What are the side effects of oxytocin?

A

minimal

NV, cardiac arrhythmias, anaphylaxis

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26
Q

What are the side effects of misoprostol?

A

shivering, diarrhea, transient temperature >38

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27
Q

What are the side effects of ergometrine?

A 
increased BP (vasoconstriction)
headache
dizziness
n/v
tinnitus
rash
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28
Q

What are the side effects of syntometrine?

A 
N/V
headache
dizziness
hypertension
arrhythmia
rash
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29
Q

What is conization of the cervix?

A

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

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30
Q

What are indications for conization of the cervix?

A

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

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31
Q

What are methods for conization of the 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)

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32
Q

What is hysteroscopy?

A

visualization inside uterus to diagnosis or treat uterine problems

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33
Q

What are indications for hysteroscopy?

A

abnormal uterine bleeding, fibroids, polyps, cancer, biopsies, remove adhesions, sterilizations, locate intrauterine device

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34
Q

Describe the surgical procedure of a hysteroscopy?

A

empty bladder (in and out catheter)
speculum into the vagina
hysterscope advanced to vagina, cervix & into the uterus
project image onto a screen
gas (CO2) or fluids (NS or LR) expands uterus

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35
Q

What are the risks of a hysterectomy?

A

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

36
Q

What is endometrial ablation?

A

destroys the endometrium (thinning of uterus)

37
Q

what is the purpose of endometrial ablation?

A

treats heavy bleeding when medications are unsuccessful

stops or reduces menstrual flow

38
Q

who is endometrial ablation not perform on?

A

post menopasual women

39
Q

When is endometrial ablation not advised?

A 
thin endometrium
endometrial hyperplasia
uterine cancer
recent pregnancy
current or recent uterine infection
40
Q

what is the surgical time of endometrial ablation?

A

30-60 minutes

41
Q

What are the risks of endometrial ablation?

A

bleeding
infection
uterine or bowel perforation
internal burns

42
Q

What is a colposcopy?

A

views the cervix using colposcope magnified 2-60x

43
Q

what is a colposcope used to assess?

A 
cervitis
uterine polyps
pain
bleeding
cervical warts
44
Q

What is tubal ligation?

A

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

45
Q

What is the surgical time for tubual ligation?

A

30 minutes

46
Q

What anesthesia can be performed for tubal ligation?

A 
epidural
spinal
combined spinal/epidural
GA
or IV sedation with local sedation
47
Q

When can a tubal ligation be performed?

A

post cesarean section w/o extending hospital stay

48
Q

Risk of tubal ligation

A

bleeding, infection

49
Q

What is endometriosis?

A

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

50
Q

What does endometriosis cause?

A

pain
irregular bleeding
adhesion
possibly infertility

51
Q

Treatment options for endometriosis

A

hormone therapy

surgical therapy

52
Q

what are surgical therapies for endometriosis?

A

diagnostic laparoscopy
excision of endometrial tissue
hysterectomy
lapartomy

53
Q

What is an ectopic pregnacy?

A

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

54
Q

What is the second leading cause of mortality ?

A

causing 15% of maternal deaths

55
Q

symptoms of ectopic pregnancy?

A 
vaginal bleeding
pelvic pain
dizziness
fainting
weakness
shoulder pain (rupture)
56
Q

What does a ruptured ectopic pregnancy require?

A

life threatening
internal bleeding
salpingectomy

57
Q

What medication is used for surgical excision of ectopic pregnancy?

A

methotrexate

58
Q

What is a hysterectomy?

A

surgical removal of the uterus

59
Q

What is the second most common major surgery among women of childbearing age?

A

hysterectomy

60
Q

A hysterectomy is a treatment for

A 
uterine fibroids
uterine prolapse
endometriosis
abnormal uterine bleeding
chronic pelvic pain
cancer
61
Q

What are the three types of hysterectomy?

A

total laparoscopic hysterectomy
laparoscopically assisted vaginal hysterectomy
robotic assisted laparoscopic hysterectomy

62
Q

What is total laparoscopic hysterectomy

A

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

63
Q

What is laparoscopically assisted vaginal hysterectomy?

A

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

64
Q

What is laparoscopic hysterectomy?

A

abdominal insufflation and use of laparoscope to visualize pelvic organs

65
Q

What are the advantages of laparoscopic hysterectomy?

A 
smaller incisions
less pain
shorter hospital stays
shorter recovery
less risk of infection and other postoperative complications
66
Q

What are the disadvantages of laparoscopic hysterectomy?

A

increase surgical time
increase risk for bladder injury
risk associated with pneumoperitonieum

67
Q

What is a radical hysterectomy?

A

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

68
Q

Indications for a radical hysterectomy

A

uterine, cervical or ovarian cancer
endometriosis
fibroids
pelvic relaxation syndrome

69
Q

Surgical time for a radical hysterectomy

A

3-4 hours

70
Q

Where is the incision for a radical hysterectomy?

A

midline or lower transverse

71
Q

What is the EBL for a radical hysterectomy?

A

1500ml

72
Q

What are the post-operative considerations for hysterectomy?

A

earlier risk for osteoporosis than menopausal women
positioning considerations
treated with estrogen therapy

73
Q

What does an oophorectomy affect?

A

caused by lack of estrogen
hot flashes
vaginal dryness
sleep problems

74
Q

What are preoperative treatments for myomectomy?

A

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

75
Q

What are anesthetic considerations for myomectomy?

A

type and crossmatch
intraoperative hemoglobin/hematocrit monitoring
IV fluid & blanket warming equipment
third space fluid loss (open approach)
surgical approach determined by type of fibroids
general or regional
prophylactic antithrombotic therapy

76
Q

What is a second look laparotomy?

A

diagnostic

most accurate method of assessing disease status in ovarian cancer

77
Q

What does second look laparotomy evaluate?

A

effectiveness of treatment
size of tumor after treatmetnt
recurrence of tumor

78
Q

What are anesthetic considerations for radical vulvectomy?

A 
chemotherapeutics
bowel preparation
general, spinal, epidural anesthesia
pca or epidural for postop pain management
foley catheter
79
Q

What is modified dorsal lithotomy?

A 
legs extended
hips abducted 30
extended 5-10
knees flexed 90
potential for nerve injury
80
Q

What is the indication for pelvic exenteration or evisceration

A

advanced or recurrent pelvic cancer

81
Q

What is the morbidity or mortality of pelvic exenteration?

A

3-5% death intraoperatively, 5 year survival

82
Q

What is included with pelvic exenteration?

A

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

83
Q

Surgical risks of pelvic exenteration

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
increased incidence of renal disease postoperatively due to urinary tract infections and obstruction

84
Q

late complications of pelvic exenteration

A

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

85
Q

Lithotomy positioning considerations

A

patient supine, legs flexed/abducted, feet at or above hip level
across perineum (table edge)
prolonged lithotomy position associated wiht compartment syndrome
femoral or peroneal nerve injury
autotransfusion- transient hemodynamic changes
caution with PVD patients
simultaneously lift legs adn hip flex to avoid dislocation

86
Q

Combined lithotomy and trendelenburg considerations

A

CVP PAP increased CO decreased

caution with CAD patients

N931 Advanced Principles (14 decks)

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