CHAPTER 30

ANAESTHESIA FOR GYNAECOLOGICAL SURGERY

Outline: Abdominal gynaecological surgery Vaginal surgery Anaesthetic techniques Special gynaecological procedures

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VAGINAL SURGERY Problems Position: The Trendelenburg or head down position can cause: − Impairment of respiration. 158 . The danger of deep vein thrombosis is more likely in pelvic surgery. Haemorrhage may occur and can often be difficult to see or measure accurately. The knees can be inside or outside the metal support but should always be well padded as nerve damage can result due to pressure from the poles. Respiratory impairment may occur especially in the obese patient. which may send the patient into cardiac failure if pre-operative cardiac disease exists. Vasoconstrictors (e. − Sudden increase in venous return. If the lithotomy position is used. − Regurgitation. − Headache. adrenaline) are often used.ABDOMINAL SURGERY This has been discussed in Chapter 28.g. Most gynaecological abdominal surgery can be done under spinal anaesthesia. then both legs should be moved together to avoid any strain on the pelvic ligaments. Post-operative vomiting is a common problem following gynaecological surgery.

For longer procedures: IV induction. mechanical ventilation with air or nitrous oxide/oxygen/volatile and a non-depolarising muscle relaxant. 159 . The patient should not be placed in this position until the spinal anaesthetic is fixed. prone with the legs supported in stirrups). LMA. Vaginal repairs ) Vaginal hysterectomy ) Spinal anaesthesia would normally be the method of choice. SPECIAL GYNAECOLOGICAL PROCEDURES Laparoscopy See under Abdominal surgery in Chapter 28 Vesico-vaginal fistula Spinal anaesthesia is best used although this can be a long procedure and the type of anaesthetic should be discussed with the surgeon in advance. intubation. spontaneous respiration using air or nitrous oxide/oxygen/volatile. Careful padding under the chest and pelvis is necessary to allow free movement of the diaphragm and upper abdomen for adequate respiration. Some surgeons may require the reverse lithotomy position (i.ANAESTHETIC TECHNIQUES Dilatation and curettage Ketamine/diazepam technique as described under Techniques of anaesthesia Chapter 14 OR Air or N2O/Oxygen/volatile with spontaneous respiration. If a general anaesthetic is required: For short procedures: IV induction.e.

160 .

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