Myomectomy

Anesthesia Implications

Position: Supine, Lithotomy, arms tucked
Time: 1-2 hours (average)
Blood Loss: High (200 – 500 ml)

Have Atropine and/or Robinul available for vagal response to uterine manipulation by the surgeon.

If you have a vagal response (reduced heart rate with possible reduction in blood pressure)
1. inform the surgeon so they can quit whatever it is they are doing
2. Simultaneously prepare Atropine/Robinul and administer if the problem persists.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

High Blood Loss (general considerations): Type and cross, CBC, and CMP should be done prior to the procedure. Consider having an A-line, blood tubing, and extra push-lines. Depending on the fragility of the patient, you may want to have blood in the room and available.

Surgical procedure to remove uterine fibroids. Most often done laparoscopically. The fibroids are excised and drawn out either through the laparoscopic holes or through an incision made in the vagina. Care will be taken to suture and repair the uterus to prevent ongoing complications.