Jaffeanesthetic Considerations For Laser Therapy To Vulva, Vagina, Cervix

Front 1

Preoperative
Respiratory


Laboratory Consider pregnancy test in young women
Premedication Consider midazolam 1–2 mg iv

Back 1

Not significant, unless there is underlying lung disease.

Front 2

Cardiovascular
Tests: ECG if >

Back 2

In elderly patients, exercise tolerance should be assessed.
50 yr

Front 3

Hematologic

Back 3

Tests: Hct

Front 4

Laboratory

Back 4

Consider pregnancy test in young women

Front 5

Premedication

Back 5

Consider midazolam 1–2 mg iv

Front 6

Intraoperative
Anesthetic technique:

Regional anesthesia: Spinal or epidural anesthesia may be used with a sensory level to T10. Provide supplemental O2 if iv sedation given.
Spinal A T10 sensory level is desirable; bupivacaine 10–12 mg can be used. Small-diameter spinal needles (e.g., 26-ga Quincke or 25-ga Sprotte needles) minimize chance of postdural puncture headache (PDPH).
Epidural 2% lidocaine, ± epinephrine 1:200,000 (10–15 mL), or 0.5% bupivacaine (10–15 mL) is used; redose as needed with 3–5 mL. Narcotics, such as morphine (4 mg) or hydromorphone (0.5 mg), may be given in the epidural for postop pain control.
Blood and fluid requirements Minimal blood loss
IV: 18 ga × 1
NS/LR at 2–4 mL/kg/h

Consider prehydrating patient if using neuraxial block.
Monitoring Standard monitors (see p. B-1).

Positioning [check mark] and pad pressure points
[check mark] eyes
Complications Eye injury
OR fires
Aerosolization of viral particles Goggles should be worn by both patient and all OR personnel during laser use to prevent injury to eyes from light. If the patient is asleep, cover eyes with saline-soaked gauze. Whenever laser is in use, be prepared for fires: know where fire extinguisher is located, and watch for improper handling of lasers. Vaporization of condyloma may produce aerosolization of viral particles; therefore, appropriate ventilation is suggested to disperse smoke.

Postoperative
Complications PONV
PDPH See p. B-6
PDPH may require epidural blood patch for treatment.

Back 6

Usually MAC; GETA/LMA or regional technique may be used.

Front 7

Sedation with

Back 7

propofol, midazolam, and fentanyl in small doses usually is effective.

Front 8

General anesthesia:
Induction
Maintenance
Muscle relaxation not necessary.

Back 8

Standard induction (see p. B-2)
Standard maintenance (see p. B-2)

Front 9

A technique with relatively rapid ? (e.g., propofol and/or sevoflurane/desflurane/N2O combinations) is useful for outpatient surgery.

Back 9

emergence

Front 10

Emergence

Back 10

Limit opiates

Front 11

Intraoperative
Anesthetic technique:

Regional anesthesia: Spinal or epidural anesthesia may be used with a sensory level to T10. Provide supplemental O2 if iv sedation given.

Back 11

Usually MAC; GETA/LMA or regional technique may be used.

Front 12

Anesthetic technique:
Sedation with propofol, midazolam, and fentanyl in ? doses usually is effective.

Back 12

small

Front 13

General anesthesia:
Induction
maintenance
Emergence

Back 13

Standard induction (see p. B-2)
Standard maintenance (see p. B-2).
Limit opiates

Front 14

Maintenance

Back 14

Muscle relaxation not necessary.

Front 15

A technique with relatively rapid ? (e.g., propofol and/or sevoflurane/desflurane/N2O combinations) is useful for outpatient surgery.

Back 15

emergence

Front 16

Spinal
Anesthetic?

Back 16

A T10 sensory level is desirable;
bupivacaine 10–12 mg can be used.

Front 17

?-diameter spinal needles minimize chance of postdural puncture headache (PDPH).

Back 17

Small (e.g., 26-ga Quincke or 25-ga Sprotte needles)

Front 18

Epidural Anesthetic dose

Back 18

2% lidocaine, ± epinephrine 1:200,000 (10–15 mL), or 0.5% bupivacaine (10–15 mL) is used; redose as needed with 3–5 mL.

Front 19

Narcotics, such as ? may be given in the epidural for postop pain control.

Back 19

morphine (4 mg) or hydromorphone (0.5 mg),

Front 20

Blood and fluid requirements Minimal blood loss
IV:
NS/LR at

Back 20

18 ga × 1
2–4 mL/kg/h

Front 21

Consider ? patient if using neuraxial block.

Back 21

prehydrating

Front 22

Monitoring Standard monitors (see p. B-1).
Positioning

Back 22

[check mark] and pad pressure points
[check mark] eyes

Front 23

Complications

Back 23

Eye injury
OR fires
Aerosolization of viral particles Goggles should be worn by both patient and all OR personnel during laser use to prevent injury to eyes from light. If the patient is asleep, cover eyes with saline-soaked gauze. Whenever laser is in use, be prepared for fires: know where fire extinguisher is located, and watch for improper handling of lasers. Vaporization of condyloma may produce aerosolization of viral particles; therefore, appropriate ventilation is suggested to disperse smoke.

Front 24

Postoperative
Complications

Back 24

PONV
PDPH See p. B-6
PDPH may require epidural blood patch for treatment.

Front 25

Pain management

Back 25

Oral analgesics e.g., acetaminophen 325–650 mg or Vicodin 1–2 tabs.