Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section E. Specialty Areas of Anesthetic Practice >

Chapter 61. Anesthesia for Obstetric Care and Gynecologic Surgery

Lawrence C. Tsen, MD

Anesthesia for Gynecologic Surgery

Topics Discussed:

abdominal surgery; anesthesia and pregnancy; anesthesia, general; anesthesia, obstetrical; antineoplastic agents; conization; cytochrome p450; dilatation and curettage; ectopic pregnancy; fallopian tube surgery; female genitalia; gynecologic anesthesia; gynecologic cancer; gynecologic surgical procedures; hysterectomy, abdominal; hysterectomy, vaginal; hysteroscopy; induced abortion, by dilation and evacuation; insufflation; laparoscopic surgery; laparoscopy; laser surgery; lesion of cervix; lithotomy position; malignant neoplasm of vulva; neuraxial nerve block; ovarian cancer; ovarian surgery; pain threshold; pelviscopy; pregnancy tests; procedure on perineum; procedure on vulva; transvaginal procedures; trendelenburg position; tubo-ovarian abscess; urethropexy; urinary incontinence, stress; urologic surgical procedures; uterine fibroids; uterine myomectomy; vagina; vulvar neoplasms.

Sections:

Preoperative Assessment and Evaluation, Intraoperative Considerations and Management, Gender Differences in Sensitivity to Pain, Gender Differences in Sensitivity to Anesthetic Agents, Anesthetic Selection and Care, Considerations for Specific Situations, Perineal and Urologic Surgery, Anatomy, Specific Procedures, Special Considerations, Transvaginal Surgery, Anatomy, Specific Procedures, Special Concerns, Intraabdominal Operations, Anatomy, Specific Procedures, Special Considerations, Transabdominal Surgery, Special Considerations

Excerpt:

"Although many of the procedures in gynecologic surgery are approached using standard surgical techniques, the care and anesthetic management should be provided with an understanding of gender-related differences that ultimately may affect patient outcomes and satisfaction. In addition to the many alterations discussed in the obstetric section of this chapter, gender-related changes in the sensitivity to pain and anesthetic agents is relevant to each case. Full appreciation should be given to the highly vascular uterus and other visceral structures found in women, which can result in sudden and profound blood loss, air emboli, and, in pregnancy-related procedures, amniotic fluid emboli.A few elements in taking a gynecologic history deserve emphasis, particularly because a few weeks may have lapsed between the gynecologic surgeon's assessment and the surgical date. The menstrual cycle can serve as a guide to other pathology and rule out the possibility of pregnancy. Abnormal or prolonged uterine bleeding can be produced by a variety of endocrine and metabolic disorders, including hypothyroidism, hyperprolactemia, coagulopathies, and insulin metabolism disorders, which in turn may impact anesthetic care. Because pregnancy has implications on surgical interventions and anesthetic care, testing should be used in individuals with absent or irregular menses, unreliable knowledge of menstrual cycle or contraceptive use, noncompliance with hormonal birth control regimens, or if the report is desired. Algorithms for the use of serum and urine..."

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