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OBJECTIVE@#To evaluate the impact of a history of vaginal delivery on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation.@*METHODS@#Ninety-nine patients undergoing hysteroscopic surgery under intravenous general anesthesia were enrolled in this study, including 43 patients with (VD group) and 56 patients without a history of vaginal delivery (NVD group). For all the patients, blood pressure, heart rate (HR), blood oxygen saturation (SpO2) and bispectral index (BIS) were recorded before anesthesia (T1), after anesthesia (T2), after cervical dilation (T3), and at 3 min after cervical dilation (T4). Propofol and etomidate doses during anesthesia induction, the total dose of propofol administered, additional intraoperative bolus dose and times of propofol, intraoperative body movement, total operation time and surgeons' satisfaction feedback scores were compared between the two groups. The postoperative awake time, recovery time, VAS score at 30 min after operation, and postoperative nausea and vomiting (PONV) were also compared.@*RESULTS@#There was no significant differences in SBP, DBP, HR, SpO2, or BIS between the two groups at T1 and T2, but at T3 and T4, SBP and DBP were significantly higher in NVD group than in VD group (P < 0.01); HR was significantly higher in NVD group only at T3 (P < 0.01). The application of vasoactive drugs did not differ significantly between the two groups. The total dose of propofol, additional intraoperative dose and times of propofol were all greater in NVD group than in VD group (P < 0.01). More body movements of the patients were observed in NVD group (P < 0.01), which also had lower surgeons' satisfaction score for anesthesia (P < 0.01), higher postoperative VAS score (P < 0.05), and shorter postoperative awake time (P < 0.05) and recovery time (P < 0.01).@*CONCLUSION@#A history of vaginal delivery has a significant impact on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation in terms of hemodynamic changes, anesthetic medication, and postoperative recovery quality, suggesting the necessity of individualized anesthesia management for these patients.
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Female , Humans , Pregnancy , Anesthesia, General , Anesthesia, Intravenous , Anesthetics, Intravenous , Cohort Studies , Delivery, Obstetric , Hysteroscopy , PropofolABSTRACT
AIM: To determine the median effective plasma concentration (Cp50) of propofol inhibiting body movement when combined with butorphanol in patients undergoing hysteroscopic surgery. METHODS: Twenty-one patients scheduled for elective hysteroscopic surgery under non-intubated intravenous anesthesia, age 20-55 years old, ASA physical status or Ⅱ, were enrolled in this study, and anesthesia was induced by target-controlled infusion of propofol. Hysteroscopy was performed only when the plasma concentration and the concentration of the effector chamber were balanced. Butorphanol 20 μg/kg was injected intravenously at 5 min before surgery. The depth of anesthesia and adverse reactions during anesthesia was monitored. The plasma target concentration (Cp) of propofol was determined by up-and-down method, the first patient was 2.5 μg/mL, each time Cp increased/decreased by 10% in the next patient depending on whether or not body movement occurred. The patients were divided into positive and negative groups according to the results. The Cp50 and 95% confidence inlerval (CI) of propofol inhibiting body movement were calculated by up-and-down formula when combined with butorphanol in patients undergoing hysteroscopic surgery. RESULTS: The Cp50(95%CI) of propofol required to inhibit body movement was 2.23(2.12-2.34) μg/mL when combined with butorphanol in patients undergoing hysteroscopic surgery. None of the patients had serious adverse reactions. CONCLUSION: The Cp50 of propofol required to inhibit body movement is 2.23 μg/mL when combined with 20 μg/kg butorphanol in patients undergoing hysteroscopic surgery. It provides a reference for safe dosage of anesthesia in hysteroscopic surgery.
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OBJECTIVE: To report hysteroscopic treatment combined with levonorgestrel-releasing intrauterine device (LNG-IUD) to treat women with early well differentiated endometrial cancer (EC) at high surgical risk. METHODS: Nine women diagnosed with stage IA, grade 1 endometrioid EC which was contraindicated or refused standard treatment with external beam radiation therapy with or without brachytherapy were enrolled in our prospective study. Endo-myometrial hysteroscopic resection of the whole uterine cavity and the placement of LNG-IUD for 5 years was performed. Response rate, perioperative complications, and recurrence of disease were evaluated. RESULTS: None had intra or post-operative complications and all were discharged no later than the third day of hospitalization. After 6 months from surgery, all the women showed a complete regression of the lesion. All the women completed the 5 years follow-up and in no case was detected sign of recurrence. Two women died for causes unrelated to the tumor or the ongoing therapy. CONCLUSION: The alternative treatment with endo-myometrial hysteroscopic resection and LNG-IUD in women with stage IA, grade 1 endometrioid EC showed initial encouraging outcomes in terms of effectiveness and safety.
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Female , Humans , Brachytherapy , Endometrial Neoplasms , Follow-Up Studies , Hospitalization , Hysteroscopy , Intrauterine Devices , Obesity , Pilot Projects , Prospective Studies , RecurrenceABSTRACT
Objective To observe intravenous lidocaine in patients undergoing hysteroscopy surgery under Narcotrend monitoring. Methods 80 patients undergoing elective hysteroscopy surgery were randomly divided into normal saline group(group S)and lidocaine group(group L). Before anesthesia induction ,group L was given lido-caine injection of 1.5 mg/kg,then with 2 mg/(kg·h)for infusion to the end of surgery. Group S received normal sa-line instead of lidocaine as the control. All patients received Narcotrend(NT)monitoring anesthesia depth of seda-tion and received intravenous anesthesia with propofol and remifentanil. Operation time (T1),dosage of propofol and remifentanil,total waking time(T2),postoperative pain of 0.5 h(T3),4 h(T4),24 h(T5)by postoperative visual analogue scale(VAS),incidence of sore throat,lidocaine adverse reactions were recorded. Results Age, weight,T1,T2 and dosage of propofol between two groups had no statistical significance (P > 0.05). Dosage of remifentanil of group L was obviously less than that in group S (P < 0.05). VAS score T3 ,T4 of group L was obviously less than those in group S(P < 0.05). No significant difference was found on T5. Sore throat incidence of group L was lower than that in group S(P < 0.05). Lidocaine adverse reactions were not found in L group. Conclusions Intravenous lidocaine in hysteroscopy surgery is safe and effective under Narcotrend monitoring.
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Objective To observe intravenous lidocaine in patients undergoing hysteroscopy surgery under Narcotrend monitoring. Methods 80 patients undergoing elective hysteroscopy surgery were randomly divided into normal saline group(group S)and lidocaine group(group L). Before anesthesia induction ,group L was given lido-caine injection of 1.5 mg/kg,then with 2 mg/(kg·h)for infusion to the end of surgery. Group S received normal sa-line instead of lidocaine as the control. All patients received Narcotrend(NT)monitoring anesthesia depth of seda-tion and received intravenous anesthesia with propofol and remifentanil. Operation time (T1),dosage of propofol and remifentanil,total waking time(T2),postoperative pain of 0.5 h(T3),4 h(T4),24 h(T5)by postoperative visual analogue scale(VAS),incidence of sore throat,lidocaine adverse reactions were recorded. Results Age, weight,T1,T2 and dosage of propofol between two groups had no statistical significance (P > 0.05). Dosage of remifentanil of group L was obviously less than that in group S (P < 0.05). VAS score T3 ,T4 of group L was obviously less than those in group S(P < 0.05). No significant difference was found on T5. Sore throat incidence of group L was lower than that in group S(P < 0.05). Lidocaine adverse reactions were not found in L group. Conclusions Intravenous lidocaine in hysteroscopy surgery is safe and effective under Narcotrend monitoring.
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Objective To compare the anesthetic effect of sufentanil combined with propofol and remifentanil combined with propofol in hysteroscopic surgery, and to provide a scientific basis for the selection of clinical anesthesia methods. Methods From November 2016 to March 2017, 94 patients in Lishui central hospital underwent hysteroscopic surgery were divided into the observation group and the control group according the anesthesia way, 47 cases in each group. The control group were given remifentanil(1 μg/kg) combined with propofol(2 mg/kg) by intravenous injection, the observation group were given sufentanil(0.2 μg/kg) combined with propofol(2 mg/kg). The mean arterial pressure(MAP), respiration (RR), pulse oxygen saturation (SpO2), heart rate (HR), the onset time of anesthesia, the postoperative recovery time, the recovery time of orientation and Ramsay sedation score in the two groups were recorded and compared before anesthesia, 2 min after anesthesia, 10 min after operation, 10min after operation finished. Results Compared with before anesthesia, MAP, RR, SpO2, HR index decreased significantly after anesthesia, the differences have statistical significance (P<0.05), the control group compared to the index value, the observation group and the control group of convergence and the decline of difference, group showed no statistically significant difference the observation group was more stable; comparison between the 10min group and MAP HR index after surgery, there was significant difference between two groups (P<0.05). The onset time of anesthesia, postoperative recovery time, orientation recovery time, Ramsay score difference between the groups was not statistically significant sedation score difference was statistically significant between group VAS, observation group than in the control group (P<0.05). Conclusion Sufentanil combined with propofol anesthesia were used in hysteroscopic surgery, which can better maintain the vital signs of patients, effectively reduce postoperative pain.
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In hysteroscopic surgery, transurethral resection of prostate (TURP) syndrome is due to the pressure and distention of uterine distention medium.A large number of uterine distention fluid absorption causes dilution hyponatremia and hypervolemia and a series of clinical symptoms.When not timely diagnosed and treated, it may become fatal.The four stage hysteroscopic surgery is the highest difficult and the most prone to TURP syndrome.This paper reviewed current situation of hysteroscopy with TURP syndrome in recent years and explored the risk factors of TURP syndrome during hysteroscopy, for a more targeted prevention of TURP syndrome.
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OBJECTIVE:To investigate effects of different doses of nalbuphine combined with propofol on anesthesia and anal-gesic effect of patients underwent hysteroscopic surgery. METHODS:A total of 120 inpatients undergoing painless hysteroscopic surgery were selected as research objects during Feb.-Nov. 2016. They were divided into group P,N1,N2,N3 according to ran-dom number table,with 30 cases in each group. Routine preoperative preparation was conducted in 4 groups. Group N1,N2,N3 were given Nalbuphine hydrochloride injection 0.05,0.10,0.15 mg/kg slowly,iv,within 1-2 min. After 3 min of injection,4 groups were given 2％ Lidocaine hydrochloride injection 2 mL,iv+ Propofol injection 1 mg/kg,iv(40 mg/10 s),and then injected with Propofol injection(10 mg/10 s)slowly until the patient's eyelash reflex disappeared and no response was aroused. During sur-gery,Propofol injection was infused with micro pump at 6 mg/(kg·h)to maintain anesthesia until the end of operation. The levels of hemodynamic parameters (SBP,DBP,HR) and SpO2 of 4 groups were observed after admission to operating room (T0),be-fore propofol infusion(T1),immediately after propofol infusion(T2),during uterine cervical distension(T3),at the end of surgery (T4) and during anesthesia recovery (T5),respectively. The induction dose,maintenance dose,total dose,total dosing time and unit time dose of propofol,anesthesia recovery time and NRS scores after anesthesia recovery of patients were also observed in 4 groups. The occurrence of ADR was recorded during operation and anesthesia recovery. RESULTS:There was no statistical signifi-cance in maintenance dose and total dosing time of propofol,the incidence of body motion reaction,hypotension,sinus bradycar-dia,nausea and vomiting among 4 groups (P>0.05). At T0,there was no statistical significance in hemodynamic parameters or SpO2 among 4 groups(P>0.05). Compared to T0,SBP of 4 groups were decreased significantly at T2,that of group N1 was de-creased significantly at T3-T4,and that of group N2 was decreased significantly at T3,with statistical significance(P<0.05). DBP of 4 groups were decreased significantly at T2,that of group N1 was decreased significantly at T3-T5,and that of group N2 was de-creased significantly at T3,with statistical significance (P<0.05). HR of group P was decreased significantly at T3,and that of group N3 was decreased significantly at T5,with statistical significance (P<0.05). SpO2 of 4 groups were decreased significantly at T2,and that of group N3 was decreased significantly at T3,with statistical significance(P<0.05). SpO2 of group N3 at T1 was significantly lower than that of group P;at T2,it was significantly lower than other groups;at T3,it was significantly lower than group P and N1,with statistical significance (P<0.05). Compared to group P,induction dose,total dose and unit time dose of propofol,NRS scores of patients were significantly decreased in group N2 and N3;the anesthesia recovery time of group N1,N2, N3 were shortened significantly,with statistical significance(P<0.05). Compared with group N1,induction dose,total dose and unit time dose of propofol,NRS scores were significantly decreased in group N2 and N3,and anesthesia recovery time of them were shortened significantly,with statistical significance(P<0.05). Compared to group N2,induction dose and total dose of pro-pofol were decreased signigficantly in group N3,with statistical significance(P<0.05). Compared with group P,the incidence of dizziness was increased significantly in group N3;compared with group P,N1,N2,the incidence of hypoxemia was increased sig-nificantly in group N3,with statistical significance (P<0.05). CONCLUSIONS:Nalbuphine 0.10 mg/kg combined with propofol for hysteroscopic surgery can achieve good anesthesia and analgesic effect with high safety.
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OBJECTIVE:To explore the intervention effects by clinical pharmacist on the use of antibacterials during periopera-tive period of hysteroscopic surgery. METHODS:250 medical records of hysteroscopic surgery were collected from July to Septem-ber in 2014(before intervention)and from October to December in 2014(after intervention). The rationality of antibacterials dur-ing perioperative period was retrospectively analyzed before and after intervention. RESULTS:After intervention by clinical pharma-cists,the antibacterial use density decreased from 47.02 DDDs/(100 persons·day)to 23.30 DDDs/(100 persons·day),and the rate of perioperative use of antibacterial decreased from 82.40% to 57.20%,with significant difference(P<0.01). The rationality of medication indicators for perioperative application of antibacterials for hysteroscope increased from 56.80%to 82.52%;the rational-ity of medication duration increased from 49.51% to 79.02%,with significant difference(P<0.05). CONCLUSIONS:Clinical pharmacist's intervention is effective and feasible to perioperative application of antibacterials for hysteroscopic surgery. It could ef-fectively promote the rational use of antibacterials.
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Acute unilateral parotid gland swelling after general anesthesia, anesthesia mumps is rare and when occurred, it is associated with the patient's position and with long-lasting surgery. The exact mechanism or etiology has not been fully established but stasis of gland secretion, blockage of Stensen's duct by direct compression, or retrograde flow of air by increased the oral cavity pressure are suspicious reasons. We experienced a case of soft tissue swelling in the left preauricular and submandibular regions in a 40-year-old female patient after short-lasting, hysteroscopic myomectomy performed in the lithotomy position with no suspicious predisposing factor. It is required to pay attention on the fact that even with the usual face mask ventilation can lead to the development of anesthesia mumps.
Subject(s)
Adult , Female , Humans , Anesthesia , Anesthesia, General , Causality , Hysteroscopy , Masks , Mouth , Mumps , Parotid Gland , Parotitis , Salivary Ducts , VentilationABSTRACT
Objective To discuss the selection of different operation methods for cesarean scar pregnancy ( CSP ) . Methods A retrospective analysis was made on clinical data of 71 CSP patients treated in our hospital from January 2010 to January 2015.All the patients were accurately diagnosed by transvaginal color ultrasound examinations.Hysteroscopic evacuation was performed in 45 endogenous CSP patients, while in 26 exogenous CSP patients, 15 of them were treated by hysteroscopy and the other 11 patients were given laparoscopic operation. Results For the 45 endogenous patients, the success rate of hysteroscopic therapy was 92%( 41/45 ) .For the 26 exogenous patients, the success rate was 80% ( 12/15 ) for hysteroscopic and 82% ( 9/11 ) for laparoscopic therapy. Conclusions Preoperative categorizing of CSP is important for choosing different surgery methods. Hysteroscopic evacuation is the first choice for endogenous CSP.For exogenous patients, both hysteroscopic evacuation and laparotomy can be chosen.Therefore, the two minimally invasive procedures have limits, and transvaginal and laparotomy resection of lesion is still necessary sometimes.
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Objective To investigate the applicative value of hysteroscopic surgery in the treatment of endogenous cesarean scar pregnancy ( CSP) . Methods A total of 34 patients with CSP in this hospital from April 2012 to October 2014 were treated by hysteroscopic surgery .Seven patients received uterine curettage under hysteroscopy and 27 patients got uterine artery embolization therapy before hysteroscopic surgery .All of them were regularly reviewed of β-hCG levels and ultrasound examinations . Results The surgical procedure was successfully completed in all the 34 cases.The operation time was (17.5 ±3.5) min, the intraoperative blood loss was (17.5 ±7.5) ml, and the hospitalization stay was 4-5 days.All of them had no serious complications .Their β-hCG levels were dropped to normal range within 28 days after operation , and all the patients had menstruation within 2 months after surgery . Conclusion Hysteroscopic surgery for CSP has advantages of good visibility , less bleeding, simple performance, high success rate, less postoperative complications , and shorter hospitalization time , being worthy of clinical utilization .
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Objective To analysis the TURP syndrome occurred in hysteroscopy surgery clinical nursing pathway. Methods According to different to our hospital nursing path of 56 women underwent hysteroscopic surgery patients were di-vided into observation group and control group.In patients with excessive hydration syndrome (TURP) chance to compare. Results two groups of patients, compared the clinical effect of observation group was better than control group , significantly fewer number of patients, TURP syndrome (p<0.05).Observation group of palace pressure, fluid volume expansion palace, palace velocity is lower than the control group, the difference is statistically significant, p<0.01).Conclusion establishing a clinical nursing path to prevent hysteroscopy surgery complicated with excessive hydration syndrome , at the same time can effectively guide the clinical nursing work, improve the hysteroscopy surgery patients, and reduce the incidence of the exces-sive hydration syndrome.
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Objective:To evaluate the value of diagnosis and therapy of cold knife conization with electro-cautery hemostasis by hysteroscope in the treatment of ceNical intraepithelial neoplasia (CIN).Methods :A retrospective analysis of the clinical data was carried out in 193 cases with CIN underwent cold knife coniza-tion with electrocautery hemostasis by hysteroscope from January 2005 to November 2008, and all patients had pathological diagnosis under colposcopic biopsy.Results:The operative time was from 15 to 40 mi-nutes, and the blood loss dunng operation was from 5 to 25 milliliters.The coincidence rate of histopathology before and after conization was 67.88% in 131 cases.9 CIN Ⅲ patients had positive margins after opera-tion, owing to scab break off bleeding of cervical wound was encountered in 18 cases.No infection and cervi-cal adhesion or stenosis occurred.Conclusions :Cold knife conization with electrocautery hemostasis by hyst-eroscope is an effective diagnosis and treatment for CIN.
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Hysteroscopic surgery has become a routine gynecologic procedure. The advantages are associated with more accurate removal of lesion, its short operating time, rapid post-operative recovery and low morbidity. However, there are potentially serious complications which can be occured during and following hysteroscopic surgery. The complications are uterine perforation, fluid overload and electrolyte disturbance due to intravasation and absorption of uterine distention media, hemorrhage and, rarely, gas or air embolism. We experienced pulmonary edema during hysteroscopic surgery in three consecutive patients. Therefore, we report these cases of fluid overload with uterine distention media resulting acute pulmonary edema during hysteroscopic surgery.
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Humans , Absorption , Hypoxia , Embolism, Air , Hemorrhage , Hysteroscopy , Pulmonary Edema , Uterine PerforationABSTRACT
OBJECTIVE: to evaluate the incidence of complications of hysteroscopic surgery. METHODS: A total of 150 patients who was done by hysteroscopic surgery from February 1997 to February 2000 were retrospectively analyzed at Choon Hae Hospital, Pusan, Korea. We classified complications into 6 groups - infection, surgeon-related complication, distension-media related complication, energy source related complication, hemorrhage and others. RESULTS: Overall complication rates were 6% (9 to 150). Surgeon-related complication rate was 1.3% (2 of 150), media-related complication rate was 0.7% (1 of 150), hemorrhage was 4% (6 of 150). And there's no complications of infection, energy-source related, or others. CONCLUSION: Hysteroscopy is a safe procedure if you know the complications of hysteroscopy & its mechanisms.
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Humans , Hemorrhage , Hysteroscopy , Incidence , Korea , Retrospective Studies , Uterine PerforationABSTRACT
OBJECTIVE: to evaluate the incidence of complications of hysteroscopic surgery. METHODS: A total of 150 patients who was done by hysteroscopic surgery from February 1997 to February 2000 were retrospectively analyzed at Choon Hae Hospital, Pusan, Korea. We classified complications into 6 groups - infection, surgeon-related complication, distension-media related complication, energy source related complication, hemorrhage and others. RESULTS: Overall complication rates were 6% (9 to 150). Surgeon-related complication rate was 1.3% (2 of 150), media-related complication rate was 0.7% (1 of 150), hemorrhage was 4% (6 of 150). And there's no complications of infection, energy-source related, or others. CONCLUSION: Hysteroscopy is a safe procedure if you know the complications of hysteroscopy & its mechanisms.