Brainscape's Knowledge GenomeTM

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


See full index

AS - N931 Advanced Principles of Anesthesia > Gynecological > Flashcards

Gynecological Flashcards

1
Q

Dilation & Curettage

A

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

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

D&C Anesthetic Considerations

A 
Emotional state
Type & screen, baseline CBC, intraop Hgb/Hct
Venous assess & fluid status
Lithotomy position
Analgesia & antiemetics
Uterine relaxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dilation & Evacuation

A 
2nd trimester 12-24 weeks
Miscarriage or elective pregnancy termination
Same approach & considerations as D&C
Vacuum aspirator & forceps
↑bleeding risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Uterotonics

A

Prevent/treat PPH
Ripen cervix & induce labor
Manage incomplete or elective abortion

  • Oxytocin
  • Pitocin
  • Mifeprex
  • Ergot alkaloids
  • Hemabate
  • Misoprostol
  • Cervidil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Oxytocin

A

Naturally produced hormone
Uterotonic acts directly on uterine smooth muscle
↑tone, rate, & strength rhythmic contractions
Secreted by posterior pituitary
Stimulates uterine contractions
Labor onset → postpartum

Prevent/treat PPH
Ripen cervix & induce labor
Manage incomplete or elective abortion

Onset 2-3 minutes
DOA 15-30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pitocin or Syntocinon

A

Synthetic oxytocin IV or IM
Uterotonic acts directly on uterine smooth muscle
↑tone, rate, & strength rhythmic contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mifeprex (Mifepristone)

A

ru486
Synthetic steroid made from norethindrone (Norplant active ingredient)
Only FDA approved non-surgical option for abortion during 1st 49 days pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ergot Alkaloids

A

Methergine (methylergonovine)

0.2mg IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hemabate (Carboprost)

A

Prostaglandin
Inject direct into myometrium 250mcg
Contraindicated in reactive airway disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Misoprostol

A

Prostaglandin E1 analog
↑myometrial Ca2+ levels
↑MLCK activity

Onset 3-5 minutes
DOA 75 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cervidil (Dinoprostone)

A

Vaginal insert 10mg
Naturally occurring biomolecule PGE2
Stimulates PGF-2a = sensitizes myometrium to oxytocin
Cervical ripening

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

Ergometrine

A

Onset 6-7 minutes
DOA 2-4 hours
↑BP (vasoconstriction), headache, dizziness, N/V, tinnitus, rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cervix Conization

A

Excision cylindrical cone-shaped wedge from the cervix
Indications - diagnosis squamous or glandular intraepithelial lesions, excluding micro-invasive carcinomas, conservative treatment cervical intraepithelial neoplasia

Scalpel, laser, electrosurgical incision loop, large loop excision of transformative zone, combination

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
Indications - 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
15
Q

Hysteroscopy Risks

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Endometrial Ablation

A 
Treats heavy bleeding when medications are unsuccessful
Destroys the endometrium (uterus lining)
Stops or reduces menstrual flow
Not performed in post-menopausal women
Surgical time 30-60 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Endometrial Ablation Risks

A

Not advised in patients w/ think endometrium, endometrial hyperplasia, uterine cancer, recent pregnancy, or current/recent uterine infection

Bleeding, infection, uterine or bowel perforation, internal burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Colposcopy

A

Typically office procedure
Visualize the cervix using colposcope magnified 2-60x
Assesses cervicitis, uterine polyps, pain, bleeding, cervical warts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tubal Ligation

A

Fallopian tubes pulled through navel, cut, and closed (sutures, bands, or clips)
Epidural, spinal, combined spinal-epidural, general anesthesia, or IV sedation w/ local
Surgical time 30 minutes
Often performed post-caesarean section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tubal Ligation Risks

A

Bleeding

Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Endometriosis

A

Endometrial growth outside uterus (ovaries, bowel, bladder, rectum, pelvic wall)
Responds to hormonal changes
Retrograde menstruation w/ suspected immune system
Causes pain, irregular bleeding, adhesions, & possible infertility

22
Q

Endometriosis Treatment

A 
Hormone therapy
Surgical intervention
- Diagnostic laparoscopy
- Endometrial tissue excision
- Hysterectomy
- Laparotomy
23
Q

Ectopic Pregnancy

A

Fertilized egg attaches outside uterus commonly in fallopian tubes
2nd leading cause maternal mortality 15% maternal deaths

24
Q

Ectopic Pregnancy S/S

A 
Vaginal bleeding
Pelvic pain
Dizziness
Fainting
Weakness
Referred shoulder pain (rupture)
25
Q

Hysterectomy

A

Surgical removal uterus
2nd most common major surgery among child-bearing age women
Approach depends on reason for surgical intervention & patient health status

26
Q

Hysterectomy Indications

A
  • Uterine fibroids
  • Endometriosis
  • Uterine prolapse
  • Abnormal uterine bleeding
  • Chronic pelvic pain
  • Cancer
27
Q

Laparoscopic Hysterectomy Types

A

Total laparoscopic hysterectomy
Laparoscopically assisted vaginal hysterectomy LAVH
Robotic-assisted laparoscopic hysterectomy

28
Q

Total Laparoscopic Hysterectomy

A

Uterus detached & removed in pieces via incisions or passed through the vagina

29
Q

Laparoscopically-Assisted Vaginal Hysterectomy

A

LAVH
Vaginal hysterectomy w/ laparoscopic assistance & visualization
Remove organs through vagina

30
Q

Laparoscopic Hysterectomy

Advantages

A

Smaller incisions
Less pain
Shorter hospital stay & recovery
Less infection risk & other postop complications

31
Q

Laparoscopic Hysterectomy

Disadvantages

A

↑surgical time
↑risk bladder injury
Pneumoperitoneum risks

32
Q

Radical Hysterectomy

A 
Removes uterus, cervix, ovaries, fallopian tubes, upper vagina, parametrium, pelvic lymph nodes
Surgical time 3-4 hours
Midline or low transverse incision
EBL 1,500mL
Type & screen
PIV x2 large bore
33
Q

Radical Hysterectomy Indications

A
  • Uterine, cervical, or ovarian cancer
  • Endometriosis
  • Fibroids
  • Pelvic relaxation syndrome
34
Q

Hysterectomy Postop Considerations

A

Oopherectomy effects similar to menopause (lack estrogen)
- Hot flashes, vaginal dryness, sleep problems
Earlier osteoporosis risk
Positioning considerations
Treated w/ estrogen therapy - pill, injection, skin patch, vaginal cream, or vaginal ring
Symptoms determine treatment form

35
Q

Myomectomy Preop Treatments

A

Multivitamins
Fe supplements
Gonadotropin releasing hormone agonist
Oral contraception

36
Q

Myomectomy Anesthetic Considerations

A 
Type & crossmatch
Intraop Hgb/Hct monitoring
IVF & blanket warming equipment
3rd space fluid loss (open approach)
Surgical approach determined by fibroids type (hysteroscopic, abdominal, laparoscopic, robotic)
General or regional anesthesia
Prophylactic antithrombotic therapy
37
Q

Second Look Laparotomy

A

Ovarian cancer diagnostic procedure
Most accurate method to assess disease status after patients complete initial therapy & clinically free disease
Evaluates treatment effectiveness, tumor size, & tumor recurrence
Negative SLL associated w/ improved survival
Same anesthetic considerations as staging laparotomy

38
Q

Radical Vulvectomy

Anesthetic Considerations

A 
Chemotherapeutics
Bowel preparation
General, spinal, or epidural anesthesia
PCA or epidural postop pain management
Foley catheter
Modified dorsal lithotomy position - legs extended, hips abducted 30°, extended 5-10°, knees flexed 90°, nerve injury potential
39
Q

Pelvic Exenteration or Evisceration

A

Remove all organs from pelvis
Radical hysterectomy, total vaginectomy, bladder excision (urostomy), urinary diversion, bowel resection & colostomy (anterior bladder & posterior rectum removed)
Indication - advanced or recurrent pelvic cancer
Morbidity & mortality 3-5% death intraop 5-year survival rate 60%
Neovagina construction available

40
Q

Pelvic Exenteration Risks

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
  • Late complications include fistula, bowel obstruction, ureteral stricture, renal failure, pyelonephritis, & chronic bowel obstructions
  • ↑incidence renal disease postop d/t urinary tract infections & obstructions
41
Q

Positioning Concerns

Lithotomy

A

Patient supine
Legs flexed/abducted w/ feet at or above hip levels (stirrups)
Access to perineum (move down towards table edge)
Prolonged lithotomy position associated w/ compartment syndrome
Femoral or peroneal nerve injury
Autotransfusion - transient hemodynamic changes
Caution w/ PVD patients
Simultaneous leg lift & hip flexion to avoid dislocation

42
Q

Lithotomy & Trendelenburg

A

↑CVP/PAP
↓CO
Caution w/ CAD patient

43
Q

Antiemetics

A 
Ondansetron 4mg (0.1mg/kg)
Reglan 10mg
Dexamethasone 4-8mg
Propofol 0.5-1mg/kg
Diphenhydramine 10-50mg IV or IM Q2-3H
Phenergan 0.25-1mg/kg (12.5-25mg IV or IM Q4-6H)
Scopolamine 2.5mg patch
Euvolemia
44
Q

Histamine H2 Receptor Antagonist

A

Cyclizine 50mg Q24H
Indication: vestibular (motion sickness)
SE: sedation, dry mouth, blurred vision, hypotension, tachycardia

45
Q

5-HT3 Receptor Antagonists

A

Ondansetron 4mg
Indication: PONV or cytotoxic drug induced vomiting
SE: headache or dizziness

46
Q

Corticosteroids

A

Dexamethasone 4-8mg IV or 0.2mg/kg
Indication: PONV or chemotherapeutics
SE: flushing, perineal itching/burning, hyperglycemia, infection, peptic ulcer, psychosis

47
Q

Muscarinic M2 Receptor Antagonist

A

Antimuscarinic
Scopolamine 1.5mg patch Q72H
Indication: motion sickness
SE: blurred vision, dry mouth, sedation

48
Q

Dopamine D2

A

Metoclopramide (Reglan) 10mg IV or 0.25mg/kg
Indication: cytotoxic drug induced
SE: abdominal cramping, restlessness, extrapyramidal effects, sedation, hypotension

49
Q

Phenothiazines

A

Promethazine (Phenergan) 12.5-25mg Q4-6H
Indication: PONV or motion sickness
SE: sedation

50
Q

Cannabinoid Receptor Antagonist

A

Dronabinol
Doses variable
Indication: cytotoxic drug induced
SE: euphoria, tachycardia, conjunctival congestion

AS - N931 Advanced Principles of Anesthesia (17 decks)

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