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Preparation for operative hysteroscopy and analgesia
Last reviewed: 19.10.2021
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Preoperative preparation for operative hysteroscopy and analgesia
Preoperative preparation for operative hysteroscopy does not differ from that in diagnostic hysteroscopy. When examining a patient and preparing for a complex hysteroscopic operation, it must be remembered that any operation can result in laparoscopy or laparotomy.
Regardless of the complexity and duration of the operation (even for the shortest manipulations) it is necessary to have a fully equipped operating room in order to recognize and start treatment of possible surgical or anesthetic complications in time.
When carrying out simple hysteroscopic operations, the same types of anesthesia are used as in diagnostic hysteroscopy. You can carry out these operations under local anesthesia (paracervical solution of novocaine or lidocaine), but it is necessary to remember about possible allergic reactions to medications that are administered. It is preferable to use intravenous anesthesia (ketalar, diprivan, sombrevin), if you do not plan a long operation (over 30 min). For longer operations, endotracheal anesthesia or epidural anesthesia can be used, but if hysteroscopy is combined with laparoscopy, in our opinion, endotracheal anesthesia is preferable.
A special problem for anesthetists is the ablation (resection) of the endometrium and myomectomy due to possible anesthesia complications and difficulties in assessing blood loss and fluid balance. In such operations, absorption of the fluid entering the uterine cavity into the vascular bed is inevitable. An anesthesiologist should monitor the balance of injected and excreted fluid and inform the surgeon about the fluid deficit. With a liquid deficit of 1000 ml, it is necessary to speed up the termination of the operation. A liquid deficit of 1500-2000 ml is an indication for an urgent termination of an operation. In an operation under general anesthesia, it is difficult to determine the signs of hyperhydration before the onset of pulmonary edema. Therefore, many anesthetists prefer to perform these operations under epidural or spinal anesthesia.
Women who refuse epidural or spinal anesthesia or who have a contraindication to this type of anesthesia are operated under endotracheal anesthesia. During the operation it is necessary to determine the concentration of blood electrolytes and preferably - CVP. When signs of fluid absorption syndrome (EFAS-Endoscopic Fluid Absorption Syndrom) appear, diuretics are injected and infusion therapy is performed under the control of blood electrolyte indices.
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