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Objective@#This study aims to establish baseline information on the practice of minimally invasive gynecologic surgery (MIGS) among Filipino gynecologic endoscopists amid the COVID-19 pandemic. @*Materials and Methods@#MATERIALS AND METHODS: An online survey was conducted among Fellows of the Philippine Society for Gynecologic Endoscopy (PSGE) practicing in private and government hospitals in the Philippines after informed consent. The survey had five subsections: (1) demographic data, (2) impact of COVID-19 pandemic on MIGS practice, (3) changes of practice during the COVID-19 pandemic, and (4) changes in the conduct of surgery and postoperative care. @*Results@#A total of 119 out of 144 PSGE Fellows based in the Philippines participated in the survey, 83% were Fellows in both laparoscopy and hysteroscopy. The majority had more than 15 years of practice and were practicing in the National Capital Region. Surgeries were canceled initially but have since resumed. The majority were hysteroscopy cases, the most common being polypectomy. Majority of the respondents reduced their clinic hours and appointments. Most have used telemedicine for consultations. Use of face masks, face shields, and personal protective equipment (PPE) were the top precautions taken in the clinics. Screening and precautions per guidelines inside the operating room setting were observed. Modifications during surgery include the use of smoke evacuators, minimizing energy device use, and wearing enhanced PPE.@*Conclusion@#The volume of laparoscopy and hysteroscopy cases was greatly reduced during the pandemic. The pandemic has disrupted the practice of MIGS both in the outpatient clinics and the operating rooms. Most of the changes made are congruent to local and international automotive task force guidelines. Precautionary measures and screening procedures must remain in place to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to patients and health-care workers.
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COVID-19 , Personal Protective Equipment , TelemedicineABSTRACT
Background@#Robotic surgery is a form of minimally invasive surgery wherein the surgeon controls the camera and instruments in a console, remote from the operating room table. Currently, the system in place is the da Vinci Surgical System which was approved by the United States Food and Drug Administration in 2000 for laparoscopic surgery. Since its approval in 2005 for Gynecologic procedures, the da Vinci Surgical System has been used for hysterectomies, lymph node dissections, sacrocolpopexies, myomectomies, and cerclage.@*Objective@#This paper presents the initial seven cases of benign gynecologic diseases operated on utilizing the da Vinci Surgical System in our institution – six hysterectomies and one myomectomy.@*Methodology@#Seven gynecologic surgeries that utilized the da Vinci Surgical System in 2019 until the first quarter of the year 2020 were done. Medical records of the seven patients were reviewed.@*Results@#The average docking time was 38 minutes (range: 25 – 65 minutes) and the average console time was 227 minutes (range: 175 – 345 minutes). The average blood loss was 576 cc (range: 80 – 1200 cc). No cases converted to an abdominal laparotomy and no morbidities were reported. While two cases underwent blood transfusion intraoperatively, all cases were stable post-operatively and were for discharge after two days. On follow-up, all patients were stable with an unremarkable clinical course.@*Conclusion@#Our initial experience demonstrates that robotic surgery appears as a viable alternative to traditional approaches. As more cases are to be done in the future, fine-tuning of the logistical set-up and surgical skills are expected, as well as venturing into other gynecologic diseases such as malignancies. Further research must be conducted on various aspects of robotic surgery, such as but not limited to outcome comparison with traditional and other laparoscopic approaches, long term outcomes, patient safety, and patient experience and preference, among others.
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Female , Gynecologic Surgical ProceduresABSTRACT
Resumen: La cirugía robótica ofrece numerosas ventajas sobre la cirugía laparoscópica convencional y la cirugía abierta. El anestesiólogo debe conocer los cambios que suceden en el paciente al ser sometido a cirugía robótica en el campo de la ginecología, urología, cirugía general, torácica y transoral. Los cambios fisiológicos son múltiples e involucran todos los sistemas: cardiovascular, respiratorio, neurológico, digestivo, renal; por lo que es de suma importancia el conocimiento de éstos para evitar complicaciones durante el período perioperatorio. De igual manera, es importante conocer el protocolo de seguridad para el retiro de los brazos del robot al verse con la necesidad de convertir la cirugía a laparoscópica o abierta. Se resumen las principales consideraciones anestésicas así como los cuidados específicos que el anestesiólogo debe tener durante cirugía robótica no cardíaca.
Abstract: Robotic surgery offers numerous advantages over conventional laparoscopic or open surgery. The anesthesiologist must have full knowledge of the physiological changes that happen when the patient undergoes robotic surgery; it being gynecological, urological, general surgery, thoracic or trans-oral surgery. There are multiple changes during robotic surgery involving the cardiovascular, respiratory, neurologic, digestive and renal systems. It is of utter importance the full knowledge of these changes in order to avoid complications during and after surgery. Also, it is important to fully know the emergency protocol for undocking if need be, to convert to laparoscopic or open surgery. We have summarized the main anesthetic considerations as well as the key points of care anesthesiologists must have during non-cardiac robotic surgery.
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Natural orifice transluminal endoscopic surgery(NOTES)is a new revolutionary surgical technique developed in the field of minimally invasive surgery.It uses endoscope to enter the chest,abdominal cavity,and so on for a variety of endoscopic operations through the natural cavity of the human body(such as mouth,stomach,vagina,bladder,rectum,etc.). Conventional NOTES is two-dimensional visualization,and the application of robotic system to NOTES can achieve three-dimensional visualization.Currently,robot-assisted NOTES in gynecologic surgeries mainly include R-LESS(Robot-assisted Laparoendoscopic Single-site Surgery)and robot-assisted vNOTES(transvaginal NOTES).The application of robot-assisted laparoscopy in gynecological natural orifice transluminal endoscopic surgery is reviewed and discussed in this paper.
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Objective To investigate the efficacy of ultrasound-guided transveses abdominis plane block ( TAP) on anesthesia and postoperative analgesia in patients undergoing gynecological laparoscopic surgery. Methods From January 2015 to July 2017,60 patients aged 46 -68 yeas,of American Society of Anesthesiologists (ASA) physical status I-II,scheduled for elective gynecological laparoscopic surgery in Nanxiang Hospital of Jiading District of Shanghai were randomly divided into control group( A group) and ultrasound-guided TAP group( B group) ,with 30 cases in each group,In B group,ultrasound-guided TAP was performed 30 min before induction of anesthesia. The patients in both two groups received patient-controlled intravenous analgesia ( PCIA) for 48 h started from 10 min before the end of surgery. The VAS score ≥4points,sufentanil 5μg was injected intravenously. The consumption of anesthesia drugs during operation,time of consciousness and extubation,the consumption of sufentanil per hour in 24h after operation,requirement for rescue medication,and the adverse reactions within 24h after surgery were also recor-ded. Results Compared with those in A group,the consumption of propofol[(210 ± 32) mg vs. (324 ± 45) mg], sufentanil[(31 ± 3. 6)μg vs. (42 ± 3. 8)μg] in operation and consumption of sufentanil per hour in 24h after operation [(3.2±0.5)μgvs.(5.4±0.7)μg?inBgroupweresignificantlylower(P<0.001).Thetimeofconsciousness [(12 ± 3)min vs. (20 ± 5)min]and extubation[(15 ± 4)min vs. (25 ± 7)min]were significantly reduced in B group (P<0. 001). The requirement for rescue medication(13％ vs. 40％) and the incidence rate of nausea(10％ vs. 33％) and vomiting(0％ vs. 10％) within 24h after surgery were significantly decreased in B group compared with those in A group (P<0. 05). Conclusion Ultrasound-guided TAP performed in patients undergoing gynecologicallaparoscopic surgery can reduce the consumption of anesthesia drugs in operation and optimize postoperative analgesia.
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BACKGROUND: To evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries.METHODS: A single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation.RESULTS: The ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634–0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis.CONCLUSION: Balloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is < 2 cm.
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Female , Humans , Constriction, Pathologic , Gynecologic Surgical Procedures , Hysterectomy , Logistic Models , Medical Records , Multivariate Analysis , Postoperative Complications , Recurrence , Retrospective Studies , UreterABSTRACT
Abstract Purpose To evaluate the anatomic and functional results of a laparoscopic modified Vecchietti technique for the creation of a neovagina in patients with congenital vaginal aplasia. Methods Retrospective study of nine patients with congenital vaginal aplasia submitted to the laparoscopic Vecchietti procedure, in our department, between 2006 and 2013. The anatomical results were evaluated by assessing the length, width and epithelialization of the neovagina at the postoperative visits. The functional outcome was evaluated using the Rosen Female Sexual Function Index (FSFI) questionnaire and comparing the patients' results to those of a control group of 20 healthy women. The statistical analysis was performed using SPSS Statistics version 19.0 (IBM, Armonk, NY, USA), Student t-test, Mann-Whitney U test and Fisher exact test. Results The condition underlying the vaginal aplasia was Mayer-Rokitansky-KüsterHauser syndrome in eight cases, and androgen insensitivity syndrome in one case. The average preoperative vaginal length was 2.9 cm. At surgery, the mean age of the patients was 22.2 years. The surgery was performed successfully in all patients and no intra or postoperative complications were recorded. At the first postoperative visit (6 to 8 weeks after surgery), the mean vaginal length was 8.1 cm. In all cases, the neovagina was epithelialized and had an appropriate width. The mean FSFI total and single domain scores did not differ significantly from those of the control group: 27.5 vs. 30.6 ( total); 4.0 vs. 4.2 (desire); 4.4 vs. 5.2 (arousal); 5.2 vs. 5.3 (lubrication); 4.2 vs. 5.0 ( orgasm); 5.3 vs. 5.5 (satisfaction) and 4.4 vs. 5.4 ( comfort ). Conclusions This modified laparoscopic Vecchietti technique is a simple, safe and effective procedure, which allows patients with congenital vaginal aplasia to have a satisfactory sexual activity, comparable to that of normal controls.
Resumo Objetivo Avaliar os resultados anatômicos e funcionais da técnica laparoscópica modificada de Vecchietti para a criação de uma neovagina em pacientes com aplasia vaginal congênita. Métodos Estudo retrospectivo de nove pacientes com aplasia vaginal congênita submetidas à técnica laparoscópica modificada de Vecchietti, no nosso departamento, entre 2006 e 2013. Os resultados anatômicos foram aferidos através da avaliação do comprimento, largura e reepitelização da neovagina nas consultas pós-operatórias. Os resultados funcionais foram avaliados com recurso à versão em português do questionário Female Sexual Function Index de Rosen, comparando os resultados das pacientes aos de um grupo de controle de 20 mulheres saudáveis. A análise estatística foi realizada utilizando o programa SPSS Statistics versão 19.0), o teste t de Student, teste U de Mann-Whitney e teste exato de Fisher. Resultados A etiologia subjacente à aplasia vaginal foi a síndrome de Mayer-Roki-tansky-Küster-Hauser em oito casos, e a síndrome de insensibilidade aos andrógenos em um caso. O comprimento vaginal médio pré-operatório era de 2,9 cm. À data da cirurgia, a média de idade das pacientes era de 22,2 anos. A cirurgia foi realizada com sucesso em todos os casos, sem registo de complicações intra ou pós-operatórias. Na primeira avaliação pós-operatória (6 a 8 semanas após a cirurgia), o comprimento vaginal médio foi de 8,1 cm. Em todos os casos, a neovagina estava reepitelizada e com amplitude adequada. As pontuações médias, total e de cada domínio, obtidas no questionário de avaliação da função sexual não diferiram significativamente das do grupo controle: 27,5 vs 30,6 (total); 4.0 vs 4.2 (desejo); 4,4 vs 5,2 (excitação); 5,2 vs 5 , 3 (lubrificação); 4,2 vs 5,0 (orgasmo); 5,3 vs 5,5 (satisfação) e 4,4 vs 5,4 ( conforto ). Conclusões A técnica laparoscópica modificada de Vecchietti é um procedimento simples, seguro e eficaz, permitindo às pacientes com aplasia vaginal congênita uma atividade sexual satisfatória, comparável à dos controles normais.
Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Gynecologic Surgical Procedures/methods , Laparoscopy , Vagina/abnormalities , Vagina/surgery , Recovery of Function , Retrospective Studies , Self Report , Sexuality , Treatment Outcome , Vagina/physiologyABSTRACT
Objective To investigate the effect of different methods of intestinal preparation on intestinal cleaning for elderly gynecological patients undergoing surgery. Methods Sixty-four elderly patients undergoing gynecological surgery were divided into two groups according to admission seguence. The control group was treated with enema using 800~1000 mL 0.2%soapy water, while the experiment group was treated with enema using sodium phosphate salt oral solution mixed with 800 ~ 1000 mL 0.9% sodium chloride solution. The intestinal cleanness and enema times of the two groups were observed. Results The effect of intestinal cleanliness in the experiment group was better than that in the control group. There was significant differences between the two groups. (P<0.01). Conclusions For the elderly patients undergoing gynecological surgery, sodium phosphate salt oral solution can not only reduce the frequency of enema but also achieve the purpose of cleaning intestinal tract, to ensure the operation effect. It is the ideal method for cleaning bowels of the elderly patients in preoperative prepartion of the surgery.
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PURPOSE: The purpose of this study was to compare desflurane anesthesia with desflurane-remifentanil anesthesia by measuring postoperative pain, nausea and vomiting after gynecologic laparoscopic surgery. METHODS: Data were collected using a random double blind method. The experimental group treated with desflurane-remifentanil anesthesia had a total of 25 patients. The control group had 20 patients who were treated with desflurane anesthesia. Pain (VAS), pushing PCA button, nausea and vomiting (VAS) were assessed at PACU (Post Anesthesia Care Unit) arrival, 10 min, 20 min, 30 min in PACU and 2 hrs, 6 hrs, 24 hrs, 48 hrs in ward. INVR was assessed at 24 hrs. Extra analgesics and extra antiemetics were measured in PACU and the ward. Data were analyzed using t-test and repeated measure using ANOVA. RESULTS: The experimental group presented with more postoperative pain (F=7.55, p<.001) than the control group. The experimental group took more extra analgesics in PACU and pressed the PCA button more often for 6 hours. The experimental group complained more postoperative nausea (F=2.11, p=.043) than the control group and took extra antiemetics during postoperative period of 24 hours. CONCLUSION: We conclude that desflurane-remifentanil anesthesia needs better management than desflurane anesthesia due to increased pain, nausea & vomiting after gynecologic laparoscopic surgery.
Subject(s)
Female , Humans , Analgesics , Anesthesia , Antiemetics , Double-Blind Method , Gynecologic Surgical Procedures , Laparoscopy , Nausea , Pain, Postoperative , Passive Cutaneous Anaphylaxis , Postoperative Nausea and Vomiting , Postoperative Period , VomitingABSTRACT
BACKGROUND: Laparoscopic surgery with reverse Trendelenburg position and carbon dioxide pneumoperitoneum has been known to increase the endotracheal tube (ETT) cuff pressure and the incidence of postoperative sore throat. The purpose of this study was to evaluate the effect of the Trendelenburg position and pneumoperitoneum on the ETT cuff pressure and the effect of adjustment of ETT cuff pressure on the incidence of sore throat during laparoscopic gynecologic surgery. METHODS: One hundred fifty-four female patients undergoing laparoscopic gynecologic surgery were randomly assigned to either control group or adjusted group. In control group, initial cuff pressure was set at 30 cmH2O in the supine position without any adjustment during surgery. Cuff pressure of adjusted group was adjusted to maintain 30 cmH2O throughout the operation. Cuff pressures at intubation (P(imme)), at carbon dioxide insufflation and the Trendelenburg position (P0), and at 10 minute intervals throughout surgery (P10-P60 and P(end)) were checked. Postoperative airway complications including sore throat, hoarseness, dysphagia and cough were compared between the two groups at 2 hours and 24 hours after surgery. RESULTS: In control group, P0 and P10 were significantly higher than P(imme). The cuff pressure decreased with time, thereby; P50 (28.2 +/- 4.3), P60 (27.5 +/- 4.0) and P(end) (25.9 +/- 4.2) were significantly lower than P(imme) (P < 0.05). The incidences and severity of airway complications were not different between two groups. CONCLUSIONS: ETT cuff pressure decreased in laparoscopic gynecologic surgery. Therefore, controlled cuff pressure does not decrease the incidence of postoperative airway complications.
Subject(s)
Female , Humans , Carbon Dioxide , Cough , Deglutition Disorders , Gynecologic Surgical Procedures , Head-Down Tilt , Hoarseness , Incidence , Insufflation , Intubation , Laparoscopy , Pharyngitis , Pneumoperitoneum , Supine PositionABSTRACT
Objective To investigate the clinical effect of laparoscopic surgery on gynecologic malignancies,providing information for the clinical therapy.Methods 35 patients with gynecologic malignancies treated with laparoscopic surgery were selected as the observation group.While 35 cases of abdominal surgery patients were selected as control group at the same period.The incidence of postoperative complications,survival rate and other conditions of the two groups were observed and compared.Results The operation time of laparoscopic surgery group was longer than open surgery group,no significant difference between the two groups(P ＞ 0.05 ).Blood loss,hospital slay and recovery time of body temperature of the laparoscopic surgery group was significantly lower than open surgery group ( P ＜0,05).2 cases had urinary retention,1 urinary tract infection and 1 deep vein thrombosis occured in observation group; while 3 urinary retention cases,1 intestinal obstruction case,1 deep vein thrombosis case,1 abdominal wound infection case occured in control group,and the difference was significant ( P ＜ 0.05 ).2 patients lost in each group.3-year survival rate of laparoscopic surgery group was similar with open surgery,the difference between the two groups was not statistically significant( P ＜ 0.01 ).Conclusion Excision and pelvic lymph node dissection under laparoscopy is an effective method in treatment of gynecologic cancer,and with less trauma and faster recovery.
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Background: Laparoscopic surgery is a recent advance in the field of gynecological surgery. There are innumerable reports in literature on its advantages and disadvantages. However, problems faced by the surgical pathologist during grossing and histopathological reporting of these morcellated specimens have never been discussed before. We present our experience and the difficulties faced by a gynecologic pathologist (first author) and try to provide some clues for their solution. Materials and Methods: Sample size was 153 consecutive laparoscopic specimens, which varied from in toto uterus with cervix, fibroid or ovarian cyst to morcellated specimens. 153 non-laparoscopic gynecologic specimens constituted controls; 34.0% were ovarian cystectomies and remaining 66.0% were hysterectomies, myomectomies and salpingectomies, of which 36.6% were morcellated, rest were in toto. Result: Contents were not seen in majority of the ovarian cystectomies. Many more sections were taken in morcellated specimens, as compared to controls, for identification of endometrium, endocervix and ectocervix. Even then, in occasional cases identification was not possible. Congested bits in morcellated specimens interpreted as endometrium on grossing turned out to be parametrial tissue. Ectocervix could be identified as soft tissue bits covered by whitish membrane. Identification of transformation zone of the cervix was not possible in any of the morcellated hysterectomy specimens. Conclusion: The advantage of laparoscopic gynecological surgery to the patient need not prove to be so for surgical pathologist. The present study does not discourage gynecologists from performing laparoscopic surgeries but wishes to highlight the surgical pathologist's problems and limitations.
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Objective To investigate the preventative effect of perioperative intervention to lower extremity deep venous thrombosis (DVT) after gynecologic surgery. Methods The 1062 patients, who received gynecologic surgery during 2007 June to 2008 June, were derided into intervention and nonintervention groups randomizely. According to the risk factors of DVT, the patients in intervention group were divided into 4 subgroups: low, mid, high and extremely high rise Each group had its own preventive measures. If patients had spontaneous pain, tenderness and swelling, positivity of Neuhof or Homan syndrome, and extension of one low extremity superficial vein, the low extremity color Doppler ultrasound would be carried out immediately. The ultrasound would also be routinely carried out in the high and extremely high risk groups in intervention group after 2 and 7 days after surgery. A prospective study was carried out investigating incidence of DVT and coagulation function perioperation. The vein blood samples were taken at in a week before surgery and 48 hours post-operation. Results The incidence of DVT of intervention group was 1.10% (6/546), and in nonintervention group, the incidence was 3.29% (17/ 516). There was significant difference between two groups (P<0.05). The incidence of DVT in extremely high risk subgroup was 21.05% (4/19), which was significantly higher than that of low(0), mid(0) and high risk groups[2.13% (2/94), P<0.05]. D-dimer, antithrombin-Ⅲ(AT-Ⅲ) post-operation were all higher than that pre-operation in the two groups, but there was no significant difference (P>0.05). The indexes of coagulation system, such as blood platelet count, prothrombin time (PT), active partial throraboplastin time (APTT), fibrinogen (Fbg), thrombin time (TT), tissue-plasminogen activator (t-PA), plasminogen activator inhibitor(PAI), were not significantly changed perioperation (P>0.05 in all pre-or post-operation indexes). Conclusions Perioperative intervention measurement according to different risk of DVT could cut down the incidence of DVT. DVT preventive intervention is suggested to high and extremely high risk people.
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Objective To investigate the effects of analgesia postoperative in patients undergoing gynecologic operation by different anesthetic methods.Methods 60 cases with gynaecological postoperative were randomly divided into spinal anesthesia group(A group) 20cases;epidural anesthesia group(B group) 20 cases;general anesthesia group(C group);the changes of respiratory and circulatory function,visual analog scale(VAS) score,patient's overall satisfaction with the analgesic effect and adverse reactions wre observed,Results A,B group after anesthesia MAP [(11.07±1.12) kPa、(11.43±1.56)kPa]lower them before anesthesia[(13.87±1.56)kPa,(14.15±1.83) kPa](t=2.156,t=2.189,P all＜0.05);A、B group pneumoperitoneum 5 min、30 min to RR,A group[(20.76±2.18) times/min、(20.13±2.69) times/min];B group [(22.76±2.15) times/min、(23.73±2.79) times/min]were higher than A,B group before anesthesia [A group (17.57±2.37)times/min,B group (17.87±2.17)times/min](t=2.156,t=2.245,t=2.289,t=3.301,t=2,285,t=2.245,t=2.231,t=2.195,P all＜0.05);The VAS score after 2,6h in C group [(0.8±0.8) points,(0,7±0,7) min]were lower than A,B group [A group (2.4±1.4) points,(1.8±1.0) points;B group(2.8±1.2)points,(2.7±2.4) min](X~2=3.945,X~2=3.911,X~2=4.031,X~2=4.111,P all＜0.05);Among the three groups the overall satisfaction with the analgesic effect and adverse reactions were no significant difference(P all＞0.05).Concluslon The general anesthesia is superior to spinal anesthesia and epidural anesthesia,but the overall analgesic effect between satisfaction was no significant difference.
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BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most frequent and distressing side effects of surgery, and approximately 50-70% of patients who undergo gynecologic surgery suffer from PONV. In this study, we evaluated the effects of various doses of ramosetron on postoperative nausea and vomiting following gynecologic surgery. METHODS: This study evaluated a randomized placebo-controlled study comprised of 200 patients who underwent gynecologic surgery under general anesthesia. The patients were divided into the following 4 groups; placebo group (saline 4 ml), R15 group (ramosetron 0.15 mg), R30 group (ramosetron 0.3 mg) and R45 group (ramosetron 0.45 mg). Each patient was administered the study drug intravenously at the completion of the operation and the presence and severity of PONV were then evaluated 24 and 48 hours after the operation. RESULTS: The incidence of PONV during the first 24 hours following surgery was lower in patients in the R30 group (44%) than in patients in the placebo group (68%)(P < 0.05). In addition, the incidence of PONV 24 to 48 hours after the operation was lower in patients in the R30 group (12%) and the R45 group (14%) than in patients in the placebo group (44%)(P < 0.05) Moreover, common side effects of 5-HT3 receptor antagonist such as headache, dizziness, and constipation did not develop in any of the groups. CONCLUSIONS: The results of this study indicate that 0.3 mg of ramosetron is the most effective dose for preventing PONV during to the first 48 hours following gynecologic surgery.
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Female , Humans , Anesthesia, General , Benzimidazoles , Constipation , Dizziness , Gynecologic Surgical Procedures , Headache , Incidence , Postoperative Nausea and Vomiting , Receptors, Serotonin, 5-HT3ABSTRACT
BACKGROUND: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) in gynecologic patients. METHODS: Sixty patients undergoing total abdominal hysterectomy or myomectomy, ASA physical status I or II, aged 30-65 yr, received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) at the end of surgery (n = 30 each). A standard general inhalational anesthesia and postoperative IV patient-controlled analgesia were used. At postoperative 3, 24 and 48 hours, we assessed pain score (VAS), incidence of PONV, rescue drug consumption, adverse events associated with study medications and overall satisfaction scores. RESULTS: The incidence of PONV showed no difference between groups at each time points after surgery (overall incidence; 59% in group R, 69% in group O). There was no difference in the severity of nausea, pain score and analgesic drug usage. However, the consumption of rescue drug in the ramosetron group was markedly less than that of ondansetron group at postoperative 3 hrs (none vs. 8 patients). No clinically serious adverse events were observed in either of the groups. Overall satisfaction scores were also comparable in both groups (6.5 +/- 3.0 vs. 6.2 +/- 2.7). CONCLUSIONS: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in women undergoing general anesthesia for gynecologic surgery. Severity of PONV seems significantly less with ramosetron than with ondansetron in the early postoperative period.
Subject(s)
Female , Humans , Analgesia, Patient-Controlled , Anesthesia , Anesthesia, General , Gynecologic Surgical Procedures , Hysterectomy , Incidence , Nausea , Ondansetron , Postoperative Nausea and Vomiting , Postoperative Period , VomitingABSTRACT
The current case describes a case of uterine rupture from placenta percreta in a woman who had only a single gynecologic surgery. We met the case of intrauterine fetal death (IUFD) with hemoperitoneum and found uterine rupture from placenta percreta by CT imaging. A 25-year-old woman was admitted to the emergency service for acute upper abdominal pain and severe hypotension at 33 weeks' gestation. She had undergone a single pelviscopic surgery due to cornual pregnancy 11 months previously. Ultrasonogram detected IUFD and hemoperitoneum. CT showed uterine rupture from placenta percreta. An emergency laparotomy was performed to correct the defect. The current case presents that placenta percreta can occur in a woman who had a single gynecologic surgery and clinicians should consider possible placenta percreta in diagnosing pregnant patients who present with acute abdominal pain and shock.
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Adult , Female , Humans , Pregnancy , Abdominal Pain , Emergencies , Fetal Death , Gynecologic Surgical Procedures , Hemoperitoneum , Hypotension , Laparotomy , Placenta Accreta , Placenta , Shock , Ultrasonography , Uterine RuptureABSTRACT
BACKGOUND: Ropivacaine and levobupivacaine are recently introduced amide local anesthetics that are structurally similar to bupivacaine. In this study, we compared the quality of postoperative analgesia and the side effects of 0.1% ropivacaine/sufentanil and 0.1% levobupivacaine/sufentanil. METHODS: Sixty patients scheduled for gynecologic surgery under general anesthesia were randomized to receive either 0.1% ropivacaine with sufentanil (ropivacaine group) or 0.1% levobupivacaine with sufentanil (levobupivacaine group) for postoperative epidural analgesia using a patient-controlled analgesia pump at a rate of 5 ml/h during the 48 hour period following surgery. Visual analogue scale (VAS) scores at rest and on coughing, sitting and movement, the degree of ambulation, additional analgesic requirements and side effects were assessed. RESULTS: In the levobupivacaine group, VAS scores at rest and on coughing, sitting and movement were lower than in the ropivacaine group (P < 0.05). In the ropivacaine group more patients were able to walk unaided (P < 0.05). There were no differences in local anesthetic consumption, additional analgesic requirements and side effects between the groups. CONCLUSIONS: Both 0.1% ropivacaine with sufentanil and 0.1% levobupivacaine with sufentanil provided effective postoperative epidural analgesia, but ropivacaine produced lesser motor block.
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Female , Humans , Analgesia , Analgesia, Epidural , Analgesia, Patient-Controlled , Anesthesia, General , Anesthetics, Local , Bupivacaine , Cough , Gynecologic Surgical Procedures , Sufentanil , WalkingABSTRACT
OBJECTIVE: This study is aimed to evaluate the efficacy and safety of intravenous iron therapy (iron III hydroxide sucrose complex) in ptatients with postoperative anemia following obstetric and gynecologic operations. METHODS: We reviewed the data of 69 patients with postoperative anemia who had undergone obstetric and gynecologic surgery from September 2003 to September 2004, who refused transfusion for correction of post-operative anemia and agreed on treatment with intravenous iron therapy. Iron III hydroxide sucrose complex 200 mg diluted in 100 mL of 0.9% sodium chloride was administrated over 2 hours on postoperative day 1st, 3rd and 5th days. Hemoglobin levels checked and side effects were reviewed. RESULTS: After treatment of intravenous iron therapy, the hemoglobin levels increased rapidly. The lowest hemoglobin levels were observed on postoperative 3rd day but rapid increase of homoglobin levels were observed continously. After 2 weeks from operation, the hemoglobin levels have increased by 0.6+/-1.3 g/dL in the patients with cesarean section and 2.1+/-1.2 g/dL in the patients with gynecology operation. Major side effects such as anaphylaxis and allergic reaction were not observed, and minor side effects were observed in three patients (4%). Emesis, pain on the injection site and skin rash was observed in each patients. CONCLUSION: Intravenous iron sucrose therapy was safe and effective in anemia following obstetric and gynecologic surgery.
Subject(s)
Female , Humans , Pregnancy , Anaphylaxis , Anemia , Cesarean Section , Exanthema , Gynecologic Surgical Procedures , Gynecology , Hypersensitivity , Iron , Sodium Chloride , Sucrose , VomitingABSTRACT
BACKGROUND: Despite new anesthetic drugs and antiemetics, the incidence of postoperative nausea and vomiting remains between 20% and 70%. The authors tested the hypothesis that seasonal diet and temperature change and preoperative gastric emptying time affects the incidence of postoperative nausea and vomiting. METHODS: We conducted a retrospective cohort study of 626 women had undergone laparoscopic hysterectomy. Patients were anesthetized with nitrous oxides and inhalation anesthetics or propofol and injected butorphanol or nalbuphine or patient-controlled analgesia for postoperative pain control. Data were collected from records of recovery room and ward nurse's record and analysed with student t-test or chi-square test and logistic regression. Results are presented as mean +/- SD; P <0.05 was considered significant. RESULTS: The incidence of PONV was 19.2%. Younger age, intraoperative dehydration, non-anemic preoperative state, usage of nalbuphine increase the incidence of PONV. But the incidence of PONV was not increased by type of anesthetic agent (inhalation or propofol), BMI, duration of operation, preoperative gastric emptyng time. CONCLUSION: There are controversy in cause of PONV. Further well-controlled, double-blind prospective study may be needed.