Chapter 10
Anesthetic Considerations
The type and specific anesthetic agent used is under the direction of the anesthesiologist. The general consensus is to use general anesthesia with intubation for performing laparoscopic hysterectomy. In a select group of patients undergoing hysterectomy, it may be possible to use a laryngeal mask along with the general anesthesia, but the final choice is in the hands of the person administering the anesthesia and depends, to a certain extent, on the patient’s body habitus and the estimated time of the procedure. From the surgeon’s point of view the following should be considered:
- Obesity
- Presence of thyroid disorder
- Cardiac disease
- Uncontrolled hypertension/diabetes
- Varicose veins
- Previous embolic history
- Combination of pelvic pathologies contributing to prolong surgical time.
Any one or a combination of the above circumstances requires a complete preoperative evaluation, a multidisciplinary approach and a joint discussion about planning an appropriate anesthetic technique. Such consultation should be performed at least a week in advance of the planned surgical date. In the event that the anesthesiologist expresses concern about laparoscopy under general anesthesia, an alternative approach may be sought. For example, if the patient has compromised respiratory compliance and cannot safely undergo pneumoperitoneum and its obligatory restriction of diaphragmatic movements, an alternative surgical option should be explored. Although age in itself is not a barrier to surgery, it may be a relative contraindication to laparoscopy depending upon the patient’s comorbid conditions which, when combined, may contraindicate the use of pneumoperitoneum at the time of surgery.
Prior to the induction of any anesthetic agent, a final checklist is reviewed by the surgeon, anesthetist and scrub nurse. This includes the introduction of the operating room personnel, confirming the identity of the patient and the nature of the procedure, estimated blood loss, probable duration of the procedure, anesthesia and surgical concerns if any. This checklist should be clearly stated so that all in the room can hear it.