The procedure is highly stimulating and requires full muscle relaxation. If using regional anesthesia, the patient requires a T4-T6 sensory level block. This can be done using a spinal, epidural or combined approach. 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. The procedure will likely be more than 2 hours, so generally a foley is placed. PONV common. Consider using a multimodal approach to prevent PONV – one of the most common is 4 mg Dexamethasone and 4 mg of Ondansetron. Surgeon may inject epinephrine or vasopressin to decrease local bleeding (monitor for brady/tachydysrythmias).
