Epidural anesthesia for hysterectomy and ureteroplasty

The article is expertly consulted by an Anesthesiologist, anesthesiologist, anesthesiologist - Department of General Surgery & Anesthesia - Vinmec Hai Phong International General Hospital.

Anesthesia in hysterectomy with ureteroplasty usually uses epidural anesthesia or a combination of spinal and epidural anesthesia. This is a regional anesthetic technique that is performed by injecting local anesthetic into the subarachnoid space and epidural space or only injecting into the epidural space to temporarily inhibit segmental nerve conduction through nerve roots to help meet the requirements of surgical anesthesia and analgesia.

Epidural anesthesia will be indicated in the following cases:
Hysterectomy with ureteroplasty in patients with genital tract cancer invading the bladder Patients with contraindications Relatively stable for endotracheal anaesthesia such as Mallampati 3 or 4, facial and neck contracture scarring that limits mouth opening, progressive tuberculosis, acute laryngitis, upper respiratory tract infection, aortic aneurysm. Helps relieve pain after surgery

The following contraindications should be noted before choosing an epidural method:
No patient consent Patient is allergic to local anesthetic There is inflammation in the needle puncture area Lack of circulation volume inadequate compensation, shock Patient has coagulopathy

Not enough time to stop anticoagulants. Mitral stenosis constricted, aortic valve constriction Severe decompensated heart failure

After successful epidural anesthesia in hysterectomy with ureteral resection, the patient should be monitored for the following signs:
Vital signs include: Consciousness, pulse, arterial blood pressure , electrocardiogram, capillary oxygen saturation Degree of sensory and motor blockade Adverse effects of epidural and spinal anesthesia

Some complications and treatment in cases of epidural anesthesia include:
Allergy, anaphylaxis to local anesthetics: Stop the anesthetic immediately and use the anti-anaphylaxis regimen according to the Ministry of Health Drug poisoning Numbness caused by mistaken injection into the blood vessel: Stopping local anesthetic, anticonvulsant, resuscitation, respiratory, circulatory, intralipid infusion in poisoning with local anesthetics bupivacaine and bupivacaine Epidural perforation: Withdraw needle, change another puncture site or switch Anesthesia method Hypotension, bradycardia: Treatment with vasopressors, atropine and fluid replacement Headache: immobilization, fluid resuscitation, use of analgesics, epidural patching with autologous blood Nausea and vomiting: Control blood pressure, use anti-emetics Urinary retention: Warm compress, bladder catheterization if necessary When anesthesia fails, need to switch to anesthesia method Vinmec International General Hospital with facilities and equipment With modern medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured that they will be examined and treated at the hospital. h hospital.