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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

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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
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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
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4
Q

Uterotonics

A

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

  • Oxytocin
  • Pitocin
  • Mifeprex
  • Ergot alkaloids
  • Hemabate
  • Misoprostol
  • Cervidil
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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

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6
Q

Pitocin or Syntocinon

A

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

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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

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8
Q

Ergot Alkaloids

A

Methergine (methylergonovine)

0.2mg IM

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9
Q

Hemabate (Carboprost)

A

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

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10
Q

Misoprostol

A

Prostaglandin E1 analog
↑myometrial Ca2+ levels
↑MLCK activity

Onset 3-5 minutes
DOA 75 minutes

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11
Q

Cervidil (Dinoprostone)

A

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

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12
Q

Ergometrine

A

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

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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

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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

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15
Q

Hysteroscopy Risks

A

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

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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
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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

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18
Q

Colposcopy

A

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

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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

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20
Q

Tubal Ligation Risks

A

Bleeding

Infection

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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
Hysterectomy
Surgical removal uterus 2nd most common major surgery among child-bearing age women Approach depends on reason for surgical intervention & patient health status
26
Hysterectomy Indications
- Uterine fibroids - Endometriosis - Uterine prolapse - Abnormal uterine bleeding - Chronic pelvic pain - Cancer
27
Laparoscopic Hysterectomy Types
Total laparoscopic hysterectomy Laparoscopically assisted vaginal hysterectomy LAVH Robotic-assisted laparoscopic hysterectomy
28
Total Laparoscopic Hysterectomy
Uterus detached & removed in pieces via incisions or passed through the vagina
29
Laparoscopically-Assisted Vaginal Hysterectomy
LAVH Vaginal hysterectomy w/ laparoscopic assistance & visualization Remove organs through vagina
30
Laparoscopic Hysterectomy | Advantages
Smaller incisions Less pain Shorter hospital stay & recovery Less infection risk & other postop complications
31
Laparoscopic Hysterectomy | Disadvantages
↑surgical time ↑risk bladder injury Pneumoperitoneum risks
32
Radical Hysterectomy
``` 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
Radical Hysterectomy Indications
- Uterine, cervical, or ovarian cancer - Endometriosis - Fibroids - Pelvic relaxation syndrome
34
Hysterectomy Postop Considerations
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
Myomectomy Preop Treatments
Multivitamins Fe supplements Gonadotropin releasing hormone agonist Oral contraception
36
Myomectomy Anesthetic Considerations
``` 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
Second Look Laparotomy
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
Radical Vulvectomy | Anesthetic Considerations
``` 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
Pelvic Exenteration or Evisceration
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
Pelvic Exenteration Risks
- 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
Positioning Concerns | Lithotomy
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
Lithotomy & Trendelenburg
↑CVP/PAP ↓CO Caution w/ CAD patient
43
Antiemetics
``` 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
Histamine H2 Receptor Antagonist
Cyclizine 50mg Q24H Indication: vestibular (motion sickness) SE: sedation, dry mouth, blurred vision, hypotension, tachycardia
45
5-HT3 Receptor Antagonists
Ondansetron 4mg Indication: PONV or cytotoxic drug induced vomiting SE: headache or dizziness
46
Corticosteroids
Dexamethasone 4-8mg IV or 0.2mg/kg Indication: PONV or chemotherapeutics SE: flushing, perineal itching/burning, hyperglycemia, infection, peptic ulcer, psychosis
47
Muscarinic M2 Receptor Antagonist
Antimuscarinic Scopolamine 1.5mg patch Q72H Indication: motion sickness SE: blurred vision, dry mouth, sedation
48
Dopamine D2
Metoclopramide (Reglan) 10mg IV or 0.25mg/kg Indication: cytotoxic drug induced SE: abdominal cramping, restlessness, extrapyramidal effects, sedation, hypotension
49
Phenothiazines
Promethazine (Phenergan) 12.5-25mg Q4-6H Indication: PONV or motion sickness SE: sedation
50
Cannabinoid Receptor Antagonist
Dronabinol Doses variable Indication: cytotoxic drug induced SE: euphoria, tachycardia, conjunctival congestion

AS - N931 Advanced Principles of Anesthesia (17 decks)

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