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Hysterectomy pp 307–319Cite as

Anaesthesia in Gynaecology

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Abstract

Gynaecologists and anaesthesiologists are both at the patient’s service when performing gynaecological procedures.This chapter emphasizes on anaesthesiological difficulties of vaginal procedures, laparotomy, laparoscopy and robotic assisted gynaecological surgery and is addressed to operating gynaecologists.

Translation revised by

Victoria Loise Ellerbroek

Anne Caroline Queisser

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Abbreviations

5HT3:

5-hydroxytriptamine

ATP:

Adenosine triphosphate

CO:

Cardiac output

CO2 :

Carbon dioxide

COPD:

Chronic obstructive pulmonary disease

CS:

Compartment syndrome

FRC:

Functional residual capacity

GnRH:

Gonadotropin-releasing hormone

HSC:

Hysteroscopy

IAP:

Intra-abdominal pressure

IOH:

Intra-operative hypotension

IUP:

Intra-uterine pressure

K+ :

Potassium

MAP:

Mean arterial pressure

MOV:

Multiple organ failure

MV:

Minute volume

NK1:

Neurokinin 1

Na+ :

Sodium

PACU:

Post anaesthesia care unit

Pinsp:

Pressure, inspiratoric

PONV:

Postoperative nausea and vomiting

RAAS:

Renin-angiotensin-aldosterone system

RR:

Respiratory rate

SIRS:

Systemic inflammatory response syndrome

TUR:

Trans-urethral resection

VC:

Vital capacity

References

  1. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91:693–700.

    Article  CAS  PubMed  Google Scholar 

  2. Koivuranta M, Laara E, Snare L, Alahuhta S. A survey of postoperative nausea and vomiting. Anaesthesia. 1997;52:443–9.

    Article  CAS  PubMed  Google Scholar 

  3. Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology. 1999;91:109–18.

    Article  CAS  PubMed  Google Scholar 

  4. Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012;109:742–53.

    Article  CAS  PubMed  Google Scholar 

  5. Apfel CC, Kranke P, Eberhart LH. Comparison of surgical site and patient’s history with a simplified risk score for the prediction of postoperative nausea and vomiting. Anaesthesia. 2004;59:1078–82.

    Article  CAS  PubMed  Google Scholar 

  6. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84:6–10.

    Article  CAS  PubMed  Google Scholar 

  7. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89:652–8.

    CAS  PubMed  Google Scholar 

  8. Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery–a prospective study. Can J Anaesth. 1998;45:612–9.

    Article  CAS  PubMed  Google Scholar 

  9. Hill RP, Lubarsky DA, Phillips-Bute B, Fortney JT, Creed MR, Glass PS, et al. Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology. 2000;92:958–67.

    Article  CAS  PubMed  Google Scholar 

  10. Eberhart LH, Geldner G, Kranke P, Morin AM, Schauffelen A, Treiber H, et al. The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients. Anesth Analg. 2004;99:1630–7. table of contents.

    Article  CAS  PubMed  Google Scholar 

  11. Recommendations for the prevention of positioning injuries during gynecologic operations. Guideline of the German Society of Gynecology and Obstetrics (AWMF Registry No. 015/077) [Internet]. 2015. Available from: http://www.awmf.org/leitlinien/detail/ll/015-077.html.

  12. Vollmar B, Westermann S, Menger MD. Microvascular response to compartment syndrome-like external pressure elevation: an in vivo fluorescence microscopic study in the hamster striated muscle. J Trauma. 1999;46:91–6.

    Article  CAS  PubMed  Google Scholar 

  13. Matsen FA, Krugmire RB, King RV. Nicolas Andry Award. Increased tissue pressure and its effects on muscle oxygenation in level and elevated human limbs. Clin Orthop Relat Res. 1979;144:311–20.

    Google Scholar 

  14. Anema JG, Morey AF, McAninch JW, Mario LA, Wessells H. Complications related to the high lithotomy position during urethral reconstruction. J Urol. 2000;164:360–3.

    Article  CAS  PubMed  Google Scholar 

  15. Bauer EC, Koch N, Janni W, Bender HG, Fleisch MC. Compartment syndrome after gynecologic operations: evidence from case reports and reviews. Eur J Obstet Gynecol Reprod Biol. 2014;173:7–12.

    Article  PubMed  Google Scholar 

  16. Matsen FA, Winquist RA, Krugmire RB. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am. 1980;62:286–91.

    Article  PubMed  Google Scholar 

  17. Shah DM, Bock DE, Darling RC, Chang BB, Kupinski AM, Leather RP. Beneficial effects of hypertonic mannitol in acute ischemia–reperfusion injuries in humans. Cardiovasc Surg. 1996;4:97–100.

    Article  CAS  PubMed  Google Scholar 

  18. Johnson DJ, Chalkiadis GA. Does epidural analgesia delay the diagnosis of lower limb compartment syndrome in children? Paediatr Anaesth. 2009;19:83–91.

    Article  PubMed  Google Scholar 

  19. Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth. 2009;102:3–11.

    Article  CAS  PubMed  Google Scholar 

  20. Cohen SA, Hurt WG. Compartment syndrome associated with lithotomy position and intermittent compression stockings. Obstet Gynecol. 2001;97:832–3.

    CAS  PubMed  Google Scholar 

  21. Montgomery CJ, Ready LB. Epidural opioid analgesia does not obscure diagnosis of compartment syndrome resulting from prolonged lithotomy position. Anesthesiology. 1991;75:541–3.

    Article  CAS  PubMed  Google Scholar 

  22. Radosa JC, Radosa MP, Sutterlin M. Acute lower limb compartment syndrome after Cesarean section: a case report. J Med Case Reports. 2011;5:161.

    Article  PubMed Central  Google Scholar 

  23. Sprung J, Abdelmalak B, Schoenwald PK. Recurrent complete heart block in a healthy patient during laparoscopic electrocauterization of the fallopian tube. Anesthesiology. 1998;88:1401–3.

    Article  CAS  PubMed  Google Scholar 

  24. Arieff AI. Hyponatremia associated with permanent brain damage. Adv Intern Med. 1987;32:325–44.

    CAS  PubMed  Google Scholar 

  25. Istre O, Bjoennes J, Naess R, Hornbaek K, Forman A. Postoperative cerebral oedema after transcervical endometrial resection and uterine irrigation with 1.5 % glycine. Lancet. 1994;344:1187–9.

    Article  CAS  PubMed  Google Scholar 

  26. Ayus JC, Wheeler JM, Arieff AI. Postoperative hyponatremic encephalopathy in menstruant women. Ann Intern Med. 1992;117:891–7.

    Article  CAS  PubMed  Google Scholar 

  27. Taskin O, Buhur A, Birincioglu M, Burak F, Atmaca R, Yilmaz I, et al. Endometrial Na+, K + −ATPase pump function and vasopressin levels during hysteroscopic surgery in patients pretreated with GnRH agonist. J Am Assoc Gynecol Laparosc. 1998;5:119–24.

    Article  CAS  PubMed  Google Scholar 

  28. Berg A, Sandvik L, Langebrekke A, Istre O. A randomized trial comparing monopolar electrodes using glycine 1.5 % with two different types of bipolar electrodes (TCRis, Versapoint) using saline, in hysteroscopic surgery. Fertil Steril. 2009;91:1273–8.

    Article  PubMed  Google Scholar 

  29. Darwish AM, Hassan ZZ, Attia AM, Abdelraheem SS, Ahmed YM. Biological effects of distension media in bipolar versus monopolar resectoscopic myomectomy: a randomized trial. J Obstet Gynaecol Res. 2010;36:810–7.

    Article  PubMed  Google Scholar 

  30. Munro MG, Storz K, Abbott JA, Falcone T, Jacobs VR, Muzii L, et al. AAGL Practice Report: Practice Guidelines for the Management of Hysteroscopic Distending Media: (Replaces Hysteroscopic Fluid Monitoring Guidelines. J Am Assoc Gynecol Laparosc. 2000;7:167–168.). J Minim Invasive Gynecol. 2013;20:137–48.

    Article  PubMed  Google Scholar 

  31. Corson SL, Brooks PG, Serden SP, Batzer FR, Gocial B. Effects of vasopressin administration during hysteroscopic surgery. J Reprod Med. 1994;39:419–23.

    CAS  PubMed  Google Scholar 

  32. Phillips DR, Nathanson HG, Milim SJ, Haselkorn JS, Khapra A, Ross PL. The effect of dilute vasopressin solution on blood loss during operative hysteroscopy: a randomized controlled trial. Obstet Gynecol. 1996;88:761–6.

    Article  CAS  PubMed  Google Scholar 

  33. Martin JD, Shenk LG. Intraoperative myocardial infarction after paracervical vasopressin infiltration. Anesth Analg. 1994;79:1201–2.

    CAS  PubMed  Google Scholar 

  34. Gonzalez R, Smith CD, McClusky DA, Ramaswamy A, Branum GD, Hunter JG, et al. Laparoscopic approach reduces likelihood of perioperative complications in patients undergoing adrenalectomy. Am Surg. 2004;70:668–74.

    PubMed  Google Scholar 

  35. Batra MS, Driscoll JJ, Coburn WA, Marks WM. Evanescent nitrous oxide pneumothorax after laparoscopy. Anesth Analg. 1983;62:1121–3.

    Article  CAS  PubMed  Google Scholar 

  36. Fitzgerald SD, Andrus CH, Baudendistel LJ, Dahms TE, Kaminski DL. Hypercarbia during carbon dioxide pneumoperitoneum. Am J Surg. 1992;163:186–90.

    Article  CAS  PubMed  Google Scholar 

  37. Sharma KC, Kabinoff G, Ducheine Y, Tierney J, Brandstetter RD. Laparoscopic surgery and its potential for medical complications. Heart Lung. 1997;26:52–64. quiz 65–7.

    Article  CAS  PubMed  Google Scholar 

  38. Ott DE. Subcutaneous emphysema–beyond the pneumoperitoneum. JSLS. 2014;18:1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  39. McAllister JD, D’Altorio RA, Snyder A. CT findings after uncomplicated percutaneous laparoscopic cholecystectomy. J Comput Assist Tomogr. 1991;15:770–2.

    Article  CAS  PubMed  Google Scholar 

  40. Celik H, Cremins A, Jones KA, Harmanli O. Massive subcutaneous emphysema in robotic sacrocolpopexy. JSLS. 2013;17:245–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Herati AS, Andonian S, Rais-Bahrami S, Atalla MA, Srinivasan AK, Richstone L, et al. Use of the valveless trocar system reduces carbon dioxide absorption during laparoscopy when compared with standard trocars. Urology. 2011;77:1126–32.

    Article  PubMed  Google Scholar 

  42. Waisbren SJ, Herz BL, Ducheine Y, Yang HK, Karanfilian RG. Iatrogenic “respiratory acidosis” during laparoscopic preperitoneal hernia repair. J Laparoendosc Surg. 1996;6:181–3.

    Article  CAS  PubMed  Google Scholar 

  43. Wolf JS, Monk TG, McDougall EM, McClennan BL, Clayman RV. The extraperitoneal approach and subcutaneous emphysema are associated with greater absorption of carbon dioxide during laparoscopic renal surgery. J Urol. 1995;154:959–63.

    Article  PubMed  Google Scholar 

  44. Gerges FJ, Kanazi GE, Jabbour-Khoury SI. Anesthesia for laparoscopy: a review. J Clin Anesth. 2006;18:67–78.

    Article  CAS  PubMed  Google Scholar 

  45. Rasmussen JP, Dauchot PJ, DePalma RG, Sorensen B, Regula G, Anton AH, et al. Cardiac function and hypercarbia. Arch Surg. 1978;113:1196–200.

    Article  CAS  PubMed  Google Scholar 

  46. Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ. Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J Trauma. 1996;40:936–41. discussion 941–3.

    Article  CAS  PubMed  Google Scholar 

  47. Awad H, Santilli S, Ohr M, Roth A, Yan W, Fernandez S, et al. The effects of steep Trendelenburg positioning on intraocular pressure during robotic radical prostatectomy. Anesth Analg. 2009;109:473–8.

    Article  PubMed  Google Scholar 

  48. Molloy BL. Implications for postoperative visual loss: steep trendelenburg position and effects on intraocular pressure. AANA J. 2011;79:115–21.

    PubMed  Google Scholar 

  49. Kaye AD, Vadivelu N, Ahuja N, Mitra S, Silasi D, Urman RD. Anesthetic considerations in robotic-assisted gynecologic surgery. Ochsner J. 2013;13:517–24.

    PubMed  PubMed Central  Google Scholar 

  50. Lee JR. Anesthetic considerations for robotic surgery. Korean J Anesthesiol. 2014;66:3–11.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Huser AS, Muller D, Brunkhorst V, Kannisto P, Musch M, Kropfl D, et al. Simulated life-threatening emergency during robot-assisted surgery. J Endourol. 2014;28:717–21.

    Article  PubMed  Google Scholar 

  52. Overgaard CB, Dzavik V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation. 2008;118:1047–56.

    Article  PubMed  Google Scholar 

  53. Tran DQH, Finlayson RJ. Use of stellate ganglion block to salvage an ischemic hand caused by the extravasation of vasopressors. Reg Anesth Pain Med. 2005;30:405–8.

    Article  PubMed  Google Scholar 

  54. Le A, Patel S. Extravasation of noncytotoxic drugs: a review of the literature. Ann Pharmacother. 2014;48(7):870–86.

    Google Scholar 

  55. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013;41:1774–81.

    Article  PubMed  Google Scholar 

  56. Cook TM, Counsell D, Wildsmith JA. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009;102:179–90.

    Article  CAS  PubMed  Google Scholar 

  57. Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology. 2004;101:950–9.

    Article  CAS  PubMed  Google Scholar 

  58. Volk T, Wolf A, Van Aken H, Burkle H, Wiebalck A, Steinfeldt T. Incidence of spinal haematoma after epidural puncture: analysis from the German network for safety in regional anaesthesia. Eur J Anaesthesiol. 2012;29:170–6.

    Article  PubMed  Google Scholar 

  59. Vigneault L, Turgeon AF, Cote D, Lauzier F, Zarychanski R, Moore L, et al. Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials. Can J Anaesth. 2011;58:22–37.

    Article  PubMed  Google Scholar 

  60. Lauretti GR. Mechanisms of analgesia of intravenous lidocaine. Rev Bras Anestesiol. 2008;58:280–6.

    Article  CAS  PubMed  Google Scholar 

  61. Koppert W, Ostermeier N, Sittl R, Weidner C, Schmelz M. Low-dose lidocaine reduces secondary hyperalgesia by a central mode of action. Pain. 2000;85:217–24.

    Article  CAS  PubMed  Google Scholar 

  62. Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology. 2000;93:858–75.

    Article  CAS  PubMed  Google Scholar 

  63. McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs. 2010;70:1149–63.

    Article  CAS  PubMed  Google Scholar 

  64. Bernard AC, Davenport DL, Chang PK, Vaughan TB, Zwischenberger JB. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg. 2009;208:931–7. 937.e1–2; discussion 938–9.

    Article  PubMed  Google Scholar 

  65. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002;288:1499–507.

    Article  PubMed  Google Scholar 

  66. Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378:1396–407.

    Article  PubMed  Google Scholar 

  67. Gombotz H, Hofmann A. Patient Blood Management : three pillar strategy to improve outcome through avoidance of allogeneic blood products. Anaesthesist. 2013;62:519–27.

    Article  CAS  PubMed  Google Scholar 

  68. Goodnough LT, Maniatis A, Earnshaw P, Benoni G, Beris P, Bisbe E, et al. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth. 2011;106:13–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Fischer DP, Zacharowski KD, Meybohm P. Savoring every drop – vampire or mosquito? Crit Care. 2014;18:306.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Sondeen JL, Coppes VG, Holcomb JB. Blood pressure at which rebleeding occurs after resuscitation in swine with aortic injury. J Trauma. 2003;54:S110–7.

    Article  PubMed  Google Scholar 

  71. Bijker JB, Gelb AW. Review article: the role of hypotension in perioperative stroke. Can J Anaesth. 2013;60:159–67.

    Article  PubMed  Google Scholar 

  72. Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KGM, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. 2007;107:213–20.

    Article  PubMed  Google Scholar 

  73. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119:507–15.

    Article  PubMed  Google Scholar 

  74. Weber CF, Zacharowski K, Meybohm P, Adam EH, Hofer S, Brun K, et al. Hemotherapy algorithms for coagulopathic cardiac surgery patients. Clin Lab. 2014;60:1059–63.

    Article  PubMed  Google Scholar 

  75. Weber CF, Zacharowski K. Perioperative point of care coagulation testing. Dtsch Arztebl Int. 2012;109:369–75.

    PubMed  PubMed Central  Google Scholar 

  76. Kozek-Langenecker S. Management of massive operative blood loss. Minerva Anestesiol. 2007;73:401–15.

    CAS  PubMed  Google Scholar 

  77. Ganter MT, Hofer CK. Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth Analg. 2008;106:1366–75.

    Article  PubMed  Google Scholar 

  78. Waurik K, Riess H, Van Aken H, Kessler P, Gogarten W, Volk T. Regional anaesthesia and thromboembolism prophylaxis/anticoagulation 3. Revised recommendations of the German Society of Anaesthesiology and Intensive Care Medicine [Internet]. 2014. Available from: http://www.awmf.org/uploads/tx_szleitlinien/001-005l_S1_R%C3%BCckenmarksnahe_Regionalan%C3%A4sthesie_Thromboembolieprophylaxe_2015-01.pdf.

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Sonntagbauer, M. (2018). Anaesthesia in Gynaecology. In: Alkatout, I., Mettler, L. (eds) Hysterectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-22497-8_20

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