1. Selection
of anesthesia methods
(I) General anesthesia
1. Application
For laparoscopic hysterectomy, general anesthesia is one of the commonly used methods. It is suitable for most patients, especially those who have a high fear of the surgical process and are difficult to cooperate with the surgical position requirements. In addition, if the patient has poor cardiopulmonary function, general anesthesia can better ensure the safety of the operation when the operation needs to be performed under strict respiratory and circulatory management. For example, elderly patients may have coronary heart disease, chronic obstructive pulmonary disease, etc. General anesthesia can effectively control breathing and maintain hemodynamic stability during the operation.
2. Selection and principle
of anesthetic drugs
General anesthesia usually involves the use of multiple drugs. Induction drugs, such as propofol, take effect quickly, can quickly make patients enter the state of anesthesia, and achieve the effect of anesthesia by inhibiting the central nervous system. Analgesics, such as fentanyl, reduce painful stimuli during surgery, and they act on opioid receptors in the central nervous system. Muscle relaxants, such as cisatracurium, can relax muscles, which is conducive to surgical operation, especially in the process of establishing pneumoperitoneum and exposing the surgical field, to ensure that the abdominal wall and pelvic muscles are in a relaxed state, which is convenient for the operation of laparoscopic instruments.
(2) Spinal anesthesia (spinal or epidural anesthesia)
1. Application
Intraspinal anesthesia may also be used for laparoscopic total hysterectomy
in some specific cases. If the patient is in good health, the operation is not expected to take a long time, and the patient has a good tolerance to intraspinal anesthesia, it can be considered. For example, in patients who are young, physically fit, and without severe cardiopulmonary disease, intraspinal anesthesia may reduce the risk of complications associated with general anesthesia.
2. Selection and principle
of anesthetic drugs Local anesthetics, such as bupivacaine and ropivacaine, are commonly used in
spinal anesthesia. These drugs are injected into the subarachnoid space (spinal anesthesia) or epidural space in the spinal canal to block nerve conduction and temporarily lose the corresponding sensory and motor nerve functions. In total hysterectomy, the lower abdomen and pelvic region can be anesthetized to achieve painless effect. However, intraspinal anesthesia requires strict control of the level of anesthesia, which may affect respiratory and circulatory function.
II. Preoperative Anesthesia Assessment
(I) Medical history collection
1. General
Doctors will ask patients about their age, weight, allergy history and so on in detail. Age is an important factor, and elderly patients may have organ function decline, tolerance to anesthetic drugs and metabolic capacity changes. Weight can also affect the dosage calculation of anesthetic drugs, and too fat or too thin need to be precisely adjusted. Allergic history determines whether certain anesthetic drugs can be used, for example, patients allergic to ester local anesthetics need to avoid the use of related drugs.
2. Past medical history
Find out whether the patient has cardiovascular disease, such as hypertension, heart disease, etc. Hypertensive patients need to control their blood pressure in an appropriate range before operation, otherwise the fluctuation of blood pressure during operation may lead to cardiovascular and cerebrovascular accidents. For patients with heart disease, cardiac function needs to be evaluated to determine the risks of surgery and anesthesia. Respiratory diseases such as asthma and chronic bronchitis are also critical, because anesthesia may affect respiratory function, preoperative assessment of pulmonary function status is needed, and appropriate respiratory management measures should be taken if necessary. In addition, patients will be asked whether they have endocrine diseases, such as diabetes, because hyperglycemia can affect wound healing and increase the risk of infection, and attention should be paid to the regulation of blood sugar during anesthesia.
3. History of operation and anesthesia
Understand the patient’s previous surgical experience and anesthesia. If patients have had adverse reactions during anesthesia, such as nausea, vomiting, allergies, etc., special attention should be paid to avoid the use of anesthetic drugs and methods that may lead to similar adverse reactions.
(2) Physical examination
1. Vital signs
Check the patient’s blood pressure, heart rate, respiratory rate, body temperature and other basic vital signs. Abnormal blood pressure or heart rate may indicate an underlying cardiovascular problem that requires further evaluation. Abnormal body temperature may affect the surgical schedule, such as fever may indicate infection, need to find out the cause and management.
2. Cardiopulmonary function test
Auscultate the heart and lungs to assess whether there is a murmur in the heart, whether the rhythm is regular, and whether the breath sounds in the lungs are normal. Abnormal heart or breath sounds may indicate cardiopulmonary disease, which is of great significance for the selection of anesthesia methods and intraoperative management. For example, the presence of wheezing in the lungs may indicate an asthma attack or an acute exacerbation of chronic bronchitis, requiring improvement in lung function preoperatively.
3. Airway assessment
Check the patient’s mouth, throat, neck and other airway conditions. Evaluate whether the patient has a difficult airway, such as difficulty in opening the mouth, limitation of neck movement, and airway stenosis caused by obesity. For patients with difficult Airways, special airway management equipment and techniques are needed to ensure the safety of breathing during anesthesia.
(3) Laboratory examination and special examination
1. Routine blood
test
Understand the patient’s hemoglobin, white blood cells, platelets and so on. Low hemoglobin levels may indicate anemia and require assessment of the patient’s ability to tolerate surgery and anesthesia, as well as preoperative blood transfusions to correct if necessary. Elevated white blood cells may indicate infection and require further investigation and management. Platelet abnormalities may affect coagulation function and increase the risk of intraoperative bleeding.
2. Coagulation function test
Including prothrombin time, partial thromboplastin time, fibrinogen and other indicators. Abnormal coagulation function may lead to bleeding during operation, and it is necessary to identify the cause before operation and take corresponding measures, such as supplementing coagulation factors or adjusting anticoagulants.
3. Liver and kidney function tests
Liver and kidney are important organs for drug metabolism and excretion. Abnormal liver function may affect the metabolism of anesthetic drugs, lead to drug accumulation in the body, and increase the occurrence of adverse reactions. Renal insufficiency may affect the excretion of drugs and their metabolites, and it is also necessary to adjust the selection and dosage of anesthetic drugs.
4. Electrocardiogram and echocardiography (if necessary)
Electrocardiogram can detect whether patients have heart problems such as arrhythmia and myocardial ischemia. For patients with a history of heart disease or ECG abnormalities, cardiac ultrasound can further assess cardiac structure and function, providing more detailed information for anesthesia management.
5. Pulmonary function test (if necessary)
For patients with respiratory diseases or high-risk factors such as older age and long-term smoking, pulmonary function test can evaluate the ventilation function and ventilation function of patients, which is helpful to predict the difficulty of intraoperative respiratory management and the risk of postoperative respiratory complications.
3. Preoperative anesthesia preparation
(I) Patient preparation
1. Fasting and water
deprivation
In order to prevent reflux and aspiration of gastric contents during anesthesia, patients need to strictly observe fasting and water deprivation time. Generally speaking, adults are fasted for 6-8 hours and deprived of water for 2-3 hours before surgery. For children, the time of fasting and water deprivation varies according to age. For example, infants are fasted for 4 hours and deprived of water for 2 hours before surgery; infants are fasted for 6 hours and deprived of water for 2-3 hours before surgery.
2. Psychological preparation
Patients often fear and worry about surgery and anesthesia, and healthcare workers need to explain the anesthesia process, possible feelings and risks to patients in detail to relieve their tension. By introducing successful cases and playing popular anesthesia videos, patients can better understand anesthesia and improve their cooperation.
3. Skin preparation
Skin preparation is performed
in the surgical area. For laparoscopic total hysterectomy, it is necessary to clean and prepare the skin in the abdomen, perineum and other possible surgical areas to reduce the risk of postoperative infection.
(II) Anesthesia equipment and drug preparation
1. Anesthesia machine and monitoring equipment
Anesthesia machine needs to be checked and debugged before operation to ensure its normal operation, to provide oxygen accurately and to control respiratory parameters. Monitoring equipment such as ECG monitor, blood oxygen saturation monitor and blood pressure monitor should be accurate and reliable so as to monitor the vital signs of patients in real time during anesthesia.
2. Anesthetic preparation
Prepare the corresponding anesthetic drugs
according to the anesthetic plan, and check the name, concentration and validity period of the drugs. For drugs that are easily allergic, anti-allergic drugs and first-aid drugs should be prepared. At the same time, the dosage of anesthetic drugs should be calculated accurately, especially for special groups such as children, the elderly, obese or emaciated patients.
3. Airway management equipment
Prepare various types of laryngoscopes, endotracheal tubes, laryngeal masks and other airway management equipment to meet the needs of airway management in different situations. For patients with difficult airway, special auxiliary equipment, such as fiberoptic bronchoscopy, should be prepared to ensure the airway safety of patients during induction and maintenance of anesthesia.
In conclusion, preoperative anesthetic assessment and preparation for laparoscopic total hysterectomy are essential. Through comprehensive evaluation and careful preparation, the most appropriate anesthesia method can be selected to ensure the safety and comfort of patients during the operation, reduce the occurrence of anesthesia-related complications, and promote the smooth rehabilitation of patients after operation.
Perineal hernia after hysterectomy
