Tag: 2017 source edit
Tag: 2017 source edit
Line 1: Line 1:
A '''hysterectomy''' is performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal|last=Morgan|first=Daniel M.|last2=Kamdar|first2=Neil S.|last3=Swenson|first3=Carolyn W.|last4=Kobernik|first4=Emily K.|last5=Sammarco|first5=Anne G.|last6=Nallamothu|first6=Brahmajee|date=2018-04|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218|journal=American Journal of Obstetrics and Gynecology|volume=218|issue=4|pages=425.e1–425.e18|doi=10.1016/j.ajog.2017.12.218|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after cesarean section in the United States<ref>{{Cite web|title=Plotting the downward trend in traditional hysterectomy|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy|access-date=2021-03-30|website=ihpi.umich.edu|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book|last=Jaffe|first=Richard A|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805|title=Anesthesiologist's manual of surgical procedures|last2=Schmiesing|first2=Clifford A|last3=Golianu|first3=Brenda|date=2014|isbn=978-1-4963-0594-7|language=English|oclc=888551588}}</ref>
{{Infobox surgical case reference
{{Infobox surgical case reference
| anesthesia_type = General
| anesthesia_type = General
Line 6: Line 4:
| lines_access = Peripheral IV
| lines_access = Peripheral IV
| monitors = Standard ASA
| monitors = Standard ASA
5 lead EKG
5-lead EKG
| considerations_preoperative = Type and cross patients at risk for hemorrhage, consider ordering blood
| considerations_preoperative = Type and cross patients at risk for hemorrhage
| considerations_intraoperative =  
| considerations_intraoperative =  
| considerations_postoperative = PONV
| considerations_postoperative = PONV
}}
}}
 
A '''hysterectomy''' is performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal|last=Morgan|first=Daniel M.|last2=Kamdar|first2=Neil S.|last3=Swenson|first3=Carolyn W.|last4=Kobernik|first4=Emily K.|last5=Sammarco|first5=Anne G.|last6=Nallamothu|first6=Brahmajee|date=2018-04|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218|journal=American Journal of Obstetrics and Gynecology|volume=218|issue=4|pages=425.e1–425.e18|doi=10.1016/j.ajog.2017.12.218|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after cesarean section in the United States<ref>{{Cite web|title=Plotting the downward trend in traditional hysterectomy|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy|access-date=2021-03-30|website=ihpi.umich.edu|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book|last=Jaffe|first=Richard A|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805|title=Anesthesiologist's manual of surgical procedures|last2=Schmiesing|first2=Clifford A|last3=Golianu|first3=Brenda|date=2014|isbn=978-1-4963-0594-7|language=English|oclc=888551588}}</ref>
.


== Preoperative management ==
== Preoperative management ==

Revision as of 09:57, 12 May 2021

Hysterectomy
Anesthesia type

General

Airway

Endotracheal tube

Lines and access

Peripheral IV

Monitors

Standard ASA 5-lead EKG

Primary anesthetic considerations
Preoperative

Type and cross patients at risk for hemorrhage

Intraoperative
Postoperative

PONV

Article quality
Editor rating
In development
User likes
0

A hysterectomy is performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.[1] It is the second-most common gynecological surgical procedure after cesarean section in the United States[2], and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.[3]

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Respiratory Many gynecological tumors are associated with cigarette smoking, assess for preexisting lung disease
Gastrointestinal
Hematologic Patients with abnormal uterine bleeding, fibroids frequently have chronic anemia
Renal
Endocrine
Labs Type and cross all patients

CBC in chronic anemia

Patient preparation and premedication

  • Midazolam
  • Consider scopolamine patch in young women at high risk for PONV

Regional and neuraxial techniques

  • Spinal or epidural can be considered in open approach

Intraoperative management

Monitoring and access

  • Standard ASA monitors
  • 5-lead EKG
  • Urinary catheter
  • 1-2 peripheral IVs (16-18 gauge)
  • In hemorrhaging patients, consider arterial line and central access

Induction and airway management

  • Standard induction
  • In unstable patients including hemorrhaging patients, consider etomidate (BP control) and rapid sequence intubation (RSI)

Positioning

  • Dorsal lithotomy position, arms tucked

Maintenance and surgical considerations

  • Intraoperative insufflation may cause:
    • Resp: atelectasis, decrease FRC, increase PIPs, and increase CO2. May also cause endobronchial intubation
    • GI: gastric content regurgitation
    • Cardiac: decreased cardiac output

Emergence

  • PONV prophylaxis, especially in young women at higher risk

Postoperative management

Disposition

  • PACU

Pain management

  • NSAIDs, acetaminophen for mild pain
  • Opioids for breakthrough pain. Consider PCA for open cases

Potential complications

  • PONV
  • Conversion to laparotomy (3.9%)
  • Urinary tract injury
  • Bowel injury
  • Vaginal cuff dehiscence
  • Hemorrhage

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

  1. Morgan, Daniel M.; Kamdar, Neil S.; Swenson, Carolyn W.; Kobernik, Emily K.; Sammarco, Anne G.; Nallamothu, Brahmajee (2018-04). "Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women". American Journal of Obstetrics and Gynecology. 218 (4): 425.e1–425.e18. doi:10.1016/j.ajog.2017.12.218. ISSN 0002-9378. Check date values in: |date= (help)
  2. "Plotting the downward trend in traditional hysterectomy". ihpi.umich.edu. Retrieved 2021-03-30.
  3. Jaffe, Richard A; Schmiesing, Clifford A; Golianu, Brenda (2014). Anesthesiologist's manual of surgical procedures. ISBN 978-1-4963-0594-7. OCLC 888551588.