Brainscape's Knowledge GenomeTM

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


See full index

N931 Advanced Principles of Anesthesia I > anesthesia for GYN surgery > Flashcards

anesthesia for GYN surgery Flashcards

1
Q

D&C

A

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

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

anesthetic considerations for D&C

A

pt’s emotional state, baseline CBC, intraop H/H, analgesia/antiemetics/uterine relaxation, venous access, volume status, availability of T&S, positioning/lithotomy

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

what is common in patients needing D&C that is fixed by having the procedure?

A

anemia

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

if any products of conception are retained what are patients at risk for?

A

bleeding

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

D&E

A

dilation and evacuation performed in 2nd trimester (between 12-24 weeks), can be for miscarriage or elective pregnancy termination, typically need to use vacuum and/or forceps

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

what kind of agents would you want on hand for a D&C or D&E?

A

uterotonic agents

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

uterotonic medications MOA

A

act directly on uterine smooth muscle

increase tone, rate, and strength of rhythmic contractions

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

Oxytocin (Pitocin)

A

naturally produced hormone
secreted by the posterior pituitary
uterotonic - stimulates uterine contractions

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

benefits/uses for uterotonics

A

prevent/treat postpartum hemorrhage
ripen cervix and induce labor
manage incomplete or elective abortion

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

how do you prepare oxytocin

A

dilute, either 10units or 20units/mL vials, give 2 units IV and put the rest in 1 L bag of LR

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

Synthetic oxytocin (pitocin or syntocinon) can be given

A

given IV or IM but usually IV diluted

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

Mifeprex is a

A

synthetic steroid made from norethindrone (active ingredient of norplant)
only FDA approved non surgical option for abortion during first 49 days of pregnancy

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

Methergine (methylergonovine)

A

semi-synthetic ergot alkaloid
prevents and controls PPH
0.2 mg IM (can repeat)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when is Methergine contraindicated?

A

HTN, gestational HTN, eclampsia, pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hemabate (Carboprost tromethamine)

A

prostaglandin F2a

250 mcg IM (can only be given IM)

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

What kind of patients do you avoid Hemabate in?

A

asthmatics!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cervidil (Dinoprostone), Prepidil, Prostin E2

A

inserted vaginally (10mg)
naturally occurring biomolecule (PGE2)
stimulates PGF-2a = sensitizes myometrium to oxytocin
causes cervical ripening for labor

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

Oxytocin IM

onset, duration, and side effects

A

Onset- 2-3 mins
DOA - 15-30 mins
SE - NV, cardiac arrhythmia, anaphylaxis

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

Misoprostol PO

onset, duration, side effects

A

onset- 3-5 minutes
DOA - 75, peak 18-34
SE - shivering, diarrhea, transient temp >38 degrees C

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

Ergometrine IM

onset, duration, side effects

A

Onset - 6-7 mins
DOA - 120-240 minutes
SE - increased BP, HA, dizziness, NV, tinnitus, rash

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

Syntometrine IM

onset, duration, side effects

A

Onset- 2-3 mins
DOA - 120-240 mins
SE - NV, HA, dizziness, HTN, arrhythmia, rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Conization of the cervix

A

excision of a cylindrical wedge from the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

indications for a conization of the cervix

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

different methods for conization of the cervix

A

scalpel, laser, electrosurgical excision loop (LEEP), large loop excision of the transformation zone (LLETZ), combo of laser and scalpel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

hysteroscopy

A

visualization inside the uterus to diagnose or treat uterine problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

indications for hysteroscopy

A

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
27
Q

surgical procedure of hysteroscopy

A

empty bladder (straight cath), speculum into vagina then hysteroscope is advanced through vagina, cervix, and into uterus, images projected on screen and gas or fluid is injected to expand the uterus to help visualize

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

risks associated with hysteroscopy

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
29
Q

why is it important to monitor fluids during a hysteroscopy?

A

instilled a lot of fluid into uterus that can get absorbed and cause hypervolemia, hyponatremia, brain swelling, metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

endometrial ablation treats

A 
heavy bleeding (>2 pads/day) when medications are unsuccessful 
destroys the endometrium and stops or reduces menstrual flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

endometrial ablation is not advised for:

A 
post menopausal women
thin endometriums
endometrial hyperplasia
uterine cancer
recent pregnancy
current or recent uterine infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

surgical time for endometrial ablation

A

30-60 minutes, no incision is made

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

risks associated with endometrial ablation

A

bleeding, infection, uterine or bowel perforation, internal burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

colposcopy

A

typically done in the office

views the cervix using a colposcope magnified 2-60x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

colposcopy is used to assess

A

cervicitis, uterine polyps, pain, bleeding, cervical warts (HPV), carcinoma

36
Q

tubal ligation

A

the fallopian tubes are pulled through the naval and cut and closed with sutures, bands, or clips

37
Q

surgical time for tubal ligation and what other procedure is it often paired with?

A

30 minutes , post-caesarian section

38
Q

risks associated with tubal ligation

A

bleeding and infection

39
Q

if the fallopian tubes are “banded” what can happen?

A

can still have an ectopic pregnancy

can be reversed

40
Q

endometriosis is

A

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

41
Q

endometriosis causes

A

pain, irregular bleeding, adhesions, and possibly infertility

42
Q

treatment options for endometriosis

A 
hormone therapy
diagnostic laparoscopy
excision of endometrial tissue
hysterectomy
laparotomy
43
Q

ectopic pregnancy is when

A

a fertilized egg is attached outside of the uterus (usually in fallopian tubes)

44
Q

ectopic pregnancy is the ___ leading cause of maternal mortality

A

2nd, 15% of maternal deaths

45
Q

symptoms of ectopic pregnancy

A

vaginal bleeding, pelvic pain, dizziness, fainting, weakness, shoulder pain (rupture)

46
Q

ruptured ectopic pregnancy

A

LIFE THREATENING

have internal bleeding and may need to have salpingectomy

47
Q

medical management of ectopic pregnancy

A

Methotrexate

48
Q

hysterectomy

A

surgical removal of uterus

49
Q

hysterectomy is the ___ most common major surgery among women of childbearing age

A

2nd

50
Q

hysterectomy is used for treatment of

A

uterine fibroids, endometriosis, uterine prolapse, abnormal uterine bleeding, chronic pelvic pain, cancer

51
Q

subtotal hysterectomy

A

body of the uterus

52
Q

total hysterectomy

A

body of uterus + cervix

53
Q

radical hysterectomy

A

body of uterus + cervix + parametrium + part of the vagina

54
Q

if the ovaries are not removed with hysterectomy then the patient won’t

A

go into early menopause

55
Q

3 types of laparoscopic hysterectomy

A
  1. total
  2. laparoscopically assisted vaginal
  3. robot assisted
56
Q

total laparoscopic hysterectomy

A

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

57
Q

laparoscopically assisted vaginal hysterectomy (LAVH)

A

vaginal hysterectomy with laparoscopic assistance with visualization and removal of organs through the vagina

58
Q

advantages of laparoscopic hysterectomy

A

smaller incisions, less pain, shorter hospital stay, shorter recovery, less risk of infection

59
Q

disadvantages of laparoscopic hysterectomy

A

increased surgical time, increased risk for bladder injury, risks associated with pneumoperitoneum

60
Q

radical hysterectomy removes

A

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

61
Q

indications for a radical hysterectomy

A

uterine, cervical or ovarian cancer
endometriosis
fibroids
pelvic relaxation syndrome

62
Q

surgical time of radical hysterectomy

A

3-4 hours

63
Q

incision and EBL for radical hysterectomy

A

midline or low transverse

EBL 1500 mL

64
Q

postop considerations for hysterectomy

A

earlier risk for osteoporosis than menopausal women

treated with estrogen therapy

65
Q

oophorectomy effects with hysterectomy caused by

A

lack of estrogen (hot flashes, vaginal dryness, sleep problems)

66
Q

myomectomy preop treatments

A

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

67
Q

anesthetic considerations for myomectomy

A

T&C, intraop H/H, IV fluid and blanket warmer, third space fluid loss with open approach, can use general or regional, prophylactic antithrombotic therapy

68
Q

second look laparotomy (SLL)

A

diagnostic
most accurate method of assessing disease status in ovarian cancer
should be clinically free of the disease because they already completed treatments

69
Q

second look laparotomy evaluates

A

effectiveness of treatment, size of a tumor after treatment, and recurrence of tumor

70
Q

radical vulvecotmy anesthetic considerations

A

given bowel prep, may be getting chemo, in modified dorsal lithotomy

71
Q

modified dorsal lithotomy

A 
legs extended
hips abducted 30 degrees
extended 5-10 degrees
knees flexed 90 degrees
potential for nerve injury.. shocker
72
Q

pelvic exenteration or evisceration (remove all organs from pelvis) indication

A

advanced or recurrent pelvic cancer

73
Q

5 year survival for pelvic exenteration

A

60%

74
Q

pelvic exenteration or evisceration procedure

A

radical hysterectomy, total vaginectomy, bladder excision, urinary diversion, bowel resection and colostomy

75
Q

surgical risks with pelvic exenteration or evisceration

A

hemorrage (internal and common iliac arteries), sepsis, wound dehiscence, anastomotic breakdown of bowel, urinary pouch, or ureteral sites, DVT, PE, stoma necrosis or reconstructive flap necrosis
increased incidence of renal disease postop d/t UTI and obstruction

76
Q

late complications of pelvic exenteration or evisceration

A

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

77
Q

antiemetics to consider for PONV

A

ondansetron, reglan, dexamethasone, propofol, diphenhydramine, phenergan, granisetron, scopolamine, euvolemia, amend

78
Q

cyclizine class, dose, side effects

A

class : histamine 1 receptor antagonist
dose: 50 mg
SE: sedation, dry mouth, blurred vision, HoTN, tachycardia

79
Q

Ondansetron class, dose, side effects

A

class: 5HT3 receptor antagonists
dose: 4 mg, 0.1mg/kg
SE: dizziness, HA

80
Q

Dexamethasone class, dose, side effects

A

class: corticosteroid
dose: 4-8 mg IV, 0.2 mg/kg
SE: flushing, perineal itch, hyperglycemia, infection, peptic ulcer, psychosis

81
Q

hyoscine class, dose, side effects

A

class: muscarinic receptor antagonist
dose: 1.5 mg patch
SE: dry mouth, blurred vision, sedation

82
Q

Metoclopramide class, dose, side effects

A

class: dopamine D2
dose: 10 mg IV, 0.25 mg/kg
SE: abdominal cramping, restlessness, exrtapyramidal effects, sedation, hypotension

83
Q

promethazine class, dose, side effects

A

class: phenothiazines
dose: 12.5-25 mg
SE: sedation

84
Q

dronabinol class, dose, side effects

A

class: cannabinoid receptor antagonist
dose: variable
SE: euphoria, tachycardia, conjunctival congestion

85
Q

lithotomy position concerns

A

prolonged = concern for compartment syndrome
femoral or peroneal nerve injury
autotransfusion
caution with PVD patients

86
Q

combined lithotomy and trendelenberg

A

CVP, PAP = increased
CO = decreased
caution with CAD patients

N931 Advanced Principles of Anesthesia I (6 decks)

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