Jaffeconization Of The Cervix

Front 1

Surgical Considerations
position
Conization
Laser Conization
Shallow Cone In Pregnancy

Back 1

Lithotomy
Lithotomy
Lithotomy; with left lateral tilt in 3rd trimester

Front 2

Incision
Conization
Laser Conization
Shallow Cone In Pregnancy

Back 2

Cervical

Front 3

Special instrumentation
Conization
Laser Conization
Shallow Cone In Pregnancy

Back 3

Conization Colposcope colposcope Laser Conization CO2 laser; protective eye wear;
Shallow Cone In Pregnancy Colposcope

Front 4

Unique considerations
Conization
Laser Conization
Shallow Cone In Pregnancy

Back 4

Infiltration of cervix with dilute vasopressin or phenylephrine solution. A 1:200,000 epinephrine solution also can be used. Vaginal pack necessary in selected patients.
⇐ same as above
Phenylephrine, vasopressin, or epinephrine should not be used during pregnancy. Liberal use of hemostatic sutures should be made.

Front 5

Antibiotics

Back 5

None

Front 6

Surgical time
Conization
Laser Conization
Shallow Cone In Pregnancy

Back 6

30–60 min
30–90 min
same as 2nd

Front 7

EBL
Conization
Laser Conization
Shallow Cone In Pregnancy

Back 7

50–200 mL
50 mL
100–350 mL

Front 8

Postop care

Back 8

Monitor for postop bleeding

Front 9

Anesthetic Considerations
Preoperative
Respiratory
Cardiovascular
Neurological

Back 9

Not usually a problem, unless there is Hx of lung disease or smoking.
These patients are generally young and, therefore, less likely to have significant heart disease.
Usually not significant, unless there is Hx of seizure disorder or other neurologic illness.

Front 10

Hematologic

Back 10

Consider hemogram

Front 11

Laboratory

Back 11

Consider pregnancy test

Front 12

Pregnancy makes it desirable to perform the procedure under

Back 12

local or regional anesthesia if appropriate.

Front 13

General anesthesia:
Induction

Back 13

Standard induction (p. B-2).

Front 14

If pregnant patient,

Back 14

rapid-sequence induction (p. B-4) with cricoid pressure is appropriate.

Front 15

Maintenance
Emergence

Back 15

Standard maintenance (p. B-2)
No special issues

Front 16

Postoperative
Complications

Back 16

Peroneal nerve injury (2° lithotomy position)
Nerve injury manifested as foot drop and loss of sensation over dorsum of foot.
PONV
Premature labor
Bleeding Tocolytic agents (e.g., terbutaline, magnesium) may be needed, consult obstetrician.

Front 17

Pain management

Back 17

Oral analgesics Consider acetaminophen or Vicodin.

Front 18

Premedication

Back 18

Consider midazolam 1–2 mg iv (Though generally held if pregnant). Na citrate 30 mL po should be given 30 min prior to induction in all pregnant patients.

Front 19

Intraoperative
Anesthetic technique:



Regional anesthesia: Both spinal and epidural techniques are acceptable, and may be preferred for pregnant patients who cannot tolerate local anesthesia. Prehydration with 1000 mL LR before block is recommended. Treat ↓BP with ephedrine 5–10 mg iv, or Neo-Synephrine 50–100 mcg, titrated to effect.
Blood and fluid requirements Minimal blood loss
IV: 18–20 ga × 1
NS/LR at 2–4 mL/kg/h
Monitoring Standard monitors (see p. B-1).

Fetal monitoring may be indicated for pregnancies > 16 wk Monitor for fetal distress or onset of labor. Mg++ or terbutaline may be necessary to suppress a sudden onset of premature labor. Consult with obstetrician on the need for these tocolytic agents. Consider having L & D nursing staff in OR if fetal monitoring used.
Positioning [check mark] and pad pressure points
[check mark] eyes *NB peroneal nerve compression at lateral fibular head → foot drop.
Left uterine displacement Left uterine displacement with a wedge under mattress should be used for pregnant patients (after ~20 wk).
Complications Laser eye damage
Fire
Premature labor If a laser is used, eye protection is required for the patient and all OR personnel; be alert for fire hazards when using a laser.

Back 19

Usually a local or MAC anesthetic; occasionally, GETA or spinal.

Front 20

Pregnancy makes it desirable to perform the procedure under

Back 20

local or regional anesthesia if appropriate.

Front 21

General anesthesia:
Induction
Maintenance
Emergence

Back 21

Standard induction (p. B-2).
Standard maintenance (p. B-2)
No special issues

Front 22

If pregnant patient,

Back 22

rapid-sequence induction (p. B-4) with cricoid pressure is appropriate.

Front 23

Regional anesthesia:
Both spinal and epidural techniques are

Back 23

acceptable, and may be preferred for pregnant patients who cannot tolerate local anesthesia.

Front 24

Prehydration with ephedrine 5–10 mg iv, or Neo-Synephrine 50–100 mcg, titrated to effect.

Back 24

1000 mL LR before block is recommended.

Front 25

Treat ↓BP with

Back 25

ephedrine 5–10 mg iv, or Neo-Synephrine 50–100 mcg, titrated to effect.

Front 26

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

Back 26

18–20 ga × 1
2–4 mL/kg/h

Front 27

Monitoring

Back 27

Standard monitors

Front 28

Fetal monitoring may be indicated for pregnancies >

Back 28

16 wk
fetal distress or onset of labor.

Front 29

may be necessary to suppress a sudden onset of premature labor.

Back 29

Mg++ or terbutaline

Front 30

Consider having ? in OR if fetal monitoring used.

Back 30

L & D nursing staff

Front 31

Positioning

Back 31

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

Front 32

Positioning
*NB peroneal nerve compression at lateral fibular head →

Back 32

foot drop.

Front 33

Left uterine displacement with a wedge under mattress should be used for pregnant patients (after ? wk).

Back 33

~20

Front 34

Postoperative
Complications See p. B-6.

Back 34

Peroneal nerve injury (2° lithotomy position)
Nerve injury manifested as foot drop and loss of sensation over dorsum of foot.
PONV
Premature labor
Bleeding Tocolytic agents (e.g., terbutaline, magnesium) may be needed, consult obstetrician.

Front 35

Pain management

Back 35

Oral analgesics Consider acetaminophen or Vicodin.

Front 36

Complications

Back 36

Laser eye damage
Fire
Premature labor
If a laser is used, eye protection is required for the patient and all OR personnel; be alert for fire hazards when using a laser.

Front 37

Regional anesthesia: Both spinal and epidural techniques are acceptable, and may be preferred for pregnant patients who cannot tolerate ?

Back 37

local anesthesia.

Front 38

Prehydration with ?

Back 38

1000 mL LR before block is recommended.

Front 39

Treat ↓BP with

Back 39

ephedrine 5–10 mg iv, or Neo-Synephrine 50–100 mcg, titrated to effect.

Front 40

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

Back 40

18–20 ga × 1
2–4 mL/kg/h