Difference between revisions of "Tubal ligation"
From WikiAnesthesia
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|Airway | |Airway | ||
| | |Airway challenges of pregnancy occur during postpartum procedures | ||
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|Neurologic | |Neurologic | ||
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|Gastrointestinal | |Gastrointestinal | ||
| | |Postpartum patients should be considered full stomach | ||
Patients should be NPO through labor and postpartum until time of surgery | |||
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|Hematologic | |Hematologic | ||
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | ||
* None | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
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=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
* Epidural from delivery can be utilized: 93% of epidural catheters were functional for postpartum tubal ligation within 1-4 hours of delivery, though only 68% of catheters were functionanl during hours 5-8 after delivery. | |||
* T4 level required for procedure | |||
* Spinal anesthesia can also be utilized | |||
== Intraoperative management == | == Intraoperative management == | ||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
* Standard monitors | |||
* 20G PIV | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
* Supine for all laparotomy/laparoscopic procedures | |||
* For transcervical procedures, lithotomy position utilized | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
Revision as of 13:12, 14 March 2022
Tubal ligation
| Anesthesia type |
GA vs. neuraxial |
|---|---|
| Airway |
ETT vs. LMA |
| Lines and access |
20G PIV |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative |
Full stomach precautions in postpartum patients |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A tubal ligation is a surgical procedure for female sterilization that involves severing and tying the fallopian tubes. Most are done laparoscopically, but at times it is performed during a C-section while the uterus is externalized. Some are done 8 hours post-partum. Recently, a transcervical method has emerged which can be performed in the doctor's office.
This procedure is 99% effective in the first year, but fallopian tubes can rarely reform or reconnect. Of those failures, 15-20% of pregnancies are likely to be ectopic.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | Airway challenges of pregnancy occur during postpartum procedures |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | Postpartum patients should be considered full stomach
Patients should be NPO through labor and postpartum until time of surgery |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
- None
Operating room setup
Patient preparation and premedication
- Timing can be intrapartum (during C-section) or at least 8 hours postpartum
Regional and neuraxial techniques
- Epidural from delivery can be utilized: 93% of epidural catheters were functional for postpartum tubal ligation within 1-4 hours of delivery, though only 68% of catheters were functionanl during hours 5-8 after delivery.
- T4 level required for procedure
- Spinal anesthesia can also be utilized
Intraoperative management
Monitoring and access
- Standard monitors
- 20G PIV
Induction and airway management
Positioning
- Supine for all laparotomy/laparoscopic procedures
- For transcervical procedures, lithotomy position utilized
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
- Bleeding
- Infection
- Damage to bowel, bladder, major vessels
- Prolonged abdominal or pelvic pain
Procedure variants
| Laparoscopic | Mini-laparotomy | Post-Partum | Transcervical | |
|---|---|---|---|---|
| Anesthetic | GA/ETT or spinal (T4 sensory block) | GA/ETT or spinal (T4 sensory block) | Epidural, spinal, or GA | GA/LMA |
| Position | Supine | Supine | Lithotomy, may need slight Trendelenburg | |
| Surgical time | 15-45 mins | 15-45 mins | In office, usually 30 mins | |
| EBL | Minimal | Minimal | Minimal | Minimal |
| Postoperative disposition | Home | |||
| Pain management | ||||
| Potential complications |
References
Top contributors: Olivia Sutton and Chris Rishel