Total Abdominal Hysterectomy (TAH)
Updated On: December 2, 2024
Anesthetic Approaches
Have atropine or glycopyrrolate (Robinul) available. These drugs are to counteract bradycardia associated with the trendelenburg position and/or vagal stimulation commonly seen with uterine procedures. Like most abdominal procedures, heat loss can be significant through the open incision. Apply an upper body convection blanket as soon as possible. Trendelenburg position implies increased CVP and PIP. Increased chances of gastric regurgitation. Surgeon may inject epinephrine or vasopressin to decrease local bleeding (monitor for brady/tachydysrythmias). PONV common. Use a multimodal approach where possible. Postoperative Pain - bilateral mid-axillary TAP and/or Ilioinguinal-Iliohypogastric blocks are very effective for postoperative pain. PCA pumps are also sometimes utilized. Use adjuncts such as NSAIDS and/or acetaminophen where possible. Foley catheter - the procedure will likely be more than 2 hours Sometimes an enlarged uterus will obstruct ureters - so be aware of kidney function.
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.
Trendelenburg Position (general considerations): Take precautions for upper airway obstruction or stridor. Avoid excessive fluid administration. OG tube is a good consideration to empty the contents of the stomach. Regurgitation of stomach contents can ulcerate the airway and/or damage the eyes. Consider throat packs and/or eye lubrication to further protect the patient. Brachial nerve injury is also a strong possibility. Be very careful with head and shoulder brace positioning. Peroneal nerve injury is a strong possibility if the patient is also in the lithotomy position. Make sure pressure points are padded. If there's peroneal nerve damage, it will manifest as foot drop. Increased IOP. Take precaution with patients that have glaucoma. Conjunctival swelling will sometimes be irritating to the patient post-operatively. Keep reminding the patient not to rub their eyes. Increased ICP. Cerebral perfusion pressure = MAP-ICP. Make sure you keep the MAP up.
Long procedure (general considerations): Procedures anticipated to last longer than 2 hours generally require a urinary catheter. Also, consider checking lines and positioning regularly as the risks of infiltration and nerve damage are increased with procedure time. Consider an IV fluid warmer and a forced air warmer to keep the patient euthermic.
This is the removal of the uterus through an incision made in the abdomen.