OBGYN Surgical Procedures
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| What are the layers of the anterior abdominal wall? | Skin to subcutaneous tissue, to superficial fascia, to external oblique muscle, to internal oblique muscle, to transversus abdominis muscle, to transversalis FASCIA, to preperiton adipose and alveolar tiss to peritoneum
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| What is the main non-anaesthetic complication in myomectomy? | haemorrhage
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| give 2 ways in which this complication can be reduced | 1. Intraoperative vasopressin into surrounding arteries
2. Preop GnRH to reduce size of fibroids
3. Blood transfusion
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| 4 non-anaesthetic complications that occur in the first 5 days postop | 1. Haemorrhage 2. Atelectasis 3. UTI/thrombophlebitis 4. Wound infection
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| Post op orders for next 24 hours or a pt under GA | 1. Clear fluids as tolerated
2. Ambulate as tolerated
3. Maintenance IV fluids (0.9% NS D5W)
4. Medications: Analgesia , Antiemetics, Antibiotics, VTE prophylaxis
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| what dose of heparin would u give as VTE prophylaxis | 5000 units sc `q8-12 hrs
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| dose of heparin in vte therapy | Bolus: 80 units/kg
infusion: 18 units/kg/hr
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| long term gynaecologic complication of myomectomy | infertility
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| For an obstetric patient on VTE prophylaxis, what is your main concern preop? | when is it safe to perform surgery without increasing the risk of hemorrhage?
when is it safe to do Sx w/o increasing the risk of thromboembolism (eg, venous, arterial) after discontinuing treatment?
aka Balance b/w bleed & clot
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| how would you preop prepare a pt on VTE prophylaxis? (wanted 4 points) | Determine risk of bleeding/VTE: 1. Coag profile: bleeding, clotting time, PT, PTT
2. Discontinue heparin preoperatively
3. Reserve 4 units of crossmatched PRBCs
4. VTE prophylaxis with thromboembolic stockings
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