Dr Mary Stocker, Consultant Anaesthetist
Mr Naru Narayanan, Consultant Gynaecologist
Torbay and South Devon NHS Foundation Trust
- All women who need surgical treatment of prolapse
- No exceptions
- All surgeons working to the same protocol
- General or Spinal Anaesthesia
- General Anaesthesia
- Induction and maintenance with target controlled propofol and alfentanil infusions.
- Spontaneous ventilation with Laryngeal Mask Airway
- Spinal Anaesthesia
- 3mls 2% hyperbaric prilocaine
- All Cases
- Always give 1 litre crystalloid as this reduces PONV and dizziness: usually do not need more than this.
- IV Dexamethasone 6.6mg and ondansetron 4mg iv for hysterectomies
- Anti-emetic medication is not routinely required for vaginal repair surgery
- Subcutaneous fragmin 5000u at end of procedure if >60 minutes
- Lithotomy position.
- Infiltration with 0.25% Bupivacaine and 1:200000 adrenaline. 20mls per compartment.
- If hysterectomy, then I use finger switch diathermy to make incisions.
- I ensure meticulous haemostasis.
- Mostly 3 pedicle hysterectomy
- If uterine size more than 12 weeks pregnancy size, then I will bisect the uterus after taking the uterine pedicle to make it easier to place a clamp around the cornual pedicles.
- No pack and no catheter as routine.
- Pre-medication with oral Ibuprofen Retard 1600mg and Paracetamol 1g.
- Intra-operative iv fentanyl 25mcg prn.
- Post-operative iv fentanyl prn, then oramorph and regular paracetamol.
Take Home Medication
- Paracetamol 500 mg/ codeine 30mg po qds, laxido 1 sachet bd, plus ibuprofen 400 mg po qds
Anticipated Day Case Rates