Stress Response to Total Abdominal Hysterectomy under General Anesthesia in Type 2 Diabetic Subjects

2013 ◽  
Vol 4 (6) ◽  
Author(s):  
Mesbahuddin Iqbal K
Keyword(s):  
Stress Response ◽  
General Anesthesia ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Type 2 Diabetic

scholarly journals Glucose, C-peptide and Cortisol Response To Surgery Under General Anesthesia In Diabetic Subjects with Treatment Variability

2009 ◽  
Vol 20 (1) ◽  
pp. 3-8
Author(s):  
K Sardar ◽  
UHS Khatun ◽  
L Ali ◽  
NN Chowdhury ◽  
KM Iqbal
Keyword(s):  
Blood Glucose ◽  
General Anesthesia ◽  
Plasma Glucose ◽  
Plasma Glucose Level ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Cortisol Response ◽  
C Peptide ◽  
Type 2 Diabetic

Diabetic patients are considered to be at increased risk of perioperative morbidity and mortality because of the involvement of their vital organs and the autonomic nervous system in the natural course of the disease. Various aspects of anesthesia and surgery cause stress induced hemodynamic, endocrine and metabolic changes in type 2 diabetic subjects. The present study was designed to investigate the surgical stress response difference between the patients groups those who are treated with only insulin and with insulin-oral hypoglycaemic drugs combination before surgery. Stress response was measured with the changes of blood glucose, C-peptide and cortisol. A total number of 30 subjects who were admitted in BIRDEM hospital in fit physical condition (ASA Class I & II) were selected for the present study. Among them 15 patients were treated with only insulin and 15 patients were treated with insulin- OHA combination before surgery. All of the subjects were received total abdominal hysterectomy under general anesthesia. Three samples were collected from each subject. The first sample (control, PT0) was collected just before anesthesia; second sample (PT1) collected 10 minutes after incision and third sample (PT2) collected 10 minutes after extubation. Plasma glucose was measured by glucose oxidase method, serum C-peptide and cortisol by chemiluminescent based ELISA technique. The mean±SD age and BMI were 44±6 years and 24.4±3.0 kg/m2 respectively. In insulin treated group, the plasma glucose level was significantly higher in PT2 and it was about 147% whereas in insulin-OHA group, the plasma glucose level was significantly higher in both PT1 (111%) and PT2 (196%). The serum C-peptide values were decreasing tendency but not significant in both groups. The serum cortisol level was increased gradually and significantly higher in PT2 in both groups. The data suggest that a) insulin treatment alone is more effective than insulin-OHA combination to control blood glucose in type 2 diabetic subjects undergoing surgery under general anesthesia, b) lower abdominal surgery under general anesthesia in well controlled type 2 diabetic subjects is accompanied by a hyperglycemic response which results from rise of insulin antagonists like cortisol rather than fall of insulin secretion, but the two treatment modalities lead to similar cortisol response. Key words: General anesthesia, Serum glucose, cortisol, Total abdominal hysterectomy Journal of BSA, Vol. 20, No. 1, January 2007 p.3-8

scholarly journals Anesthetic management of an achondroplastic dwarf with difficult airway and kyphoscoliosis for total abdominal hysterectomy

2021 ◽  
Vol 8 (3) ◽  
pp. 475-478
Author(s):  
Tejaswini L Phalke ◽  
Jyoti P Deshpande ◽  
Jyoti H Kale ◽  
Madhavi R Godbole
Keyword(s):  
General Anesthesia ◽  
Difficult Airway ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Neurological Injury ◽  
Fiberoptic Intubation ◽  
Short Neck ◽  
Neck Movement ◽  
Neck Extension ◽  
Awake Fiberoptic Intubation

Achondroplasia is a common form of dwarfism and possesses multiple anesthetic challenges including securing of intravenous line, monitoring and calculating drug dosage, spine abnormality, difficulty in mask ventilation and endotracheal intubation, obesity, cardiopulmonary and neurological system abnormality. There is multiple systems involvement, therefore thorough preanesthetic check ups, investigations and planning for anesthesia is important. Here we came across 36 years old female patient, achondroplasic dwarf (height- 100cm) with thoracolumbar kyphoscoliosis, fused cervical spine, short neck and restricted neck movement with mild pulmonary restrictive disease for total abdominal hysterectomy. Patient also had complained of generalized weakness and fatigue. She had a limited neck extension and short neck possesses anticipated difficult intubation, therefore we planned awake fiberoptic intubation with smaller size endotracheal tube for airway management and general anesthesia in a patient with difficult airway and spine for total abdominal hysterectomy. As the spread of the drug in regional anesthesia is unpredicted, we planned general anesthesia with awake fiberoptic intubation to avoid the risk of neurological injury while extending the neck during laryngoscopy for tracheal intubation due to restricted neck movement.

scholarly journals Anesthesia Management at Postpartum et causa Atonic Uteri Bleeding in P3A0H3 Post SCTP Outside Dr. Moewardi Hospital

2021 ◽  
Vol 1 (1) ◽  
pp. 34
Author(s):  
RTh Supraptomo ◽  
Muhammad Ridho Aditya
Keyword(s):  
General Anesthesia ◽  
Postpartum Hemorrhage ◽  
Hypovolemic Shock ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Emergency Laparotomy ◽  
Excessive Bleeding ◽  
Mortality And Morbidity ◽  
Anesthesia Management ◽  
Intraoperative Management

<p>Postpartum hemorrhage remains the leading cause of maternal mortality and morbidity worldwide, happens more in developing countries with an estimated mortality rate of 140,000 per year or one maternal death every four minutes</p><p>To understand anesthesia management at postpartum et causa atonic uteri bleeding outside Dr. Moewardi hospital</p><p>In this case reported 25 years old patient was admitted to the emergency room at Dr. Moewardi Hospital Surakarta, on the 28/11/2019 at 15.30 WIB, sent by Waras Hospital Wiris Boyolali. On examination found the patient in a state of weakness, apathy awareness and blood pressure 90/60, heart rate 130, respiration rate 22, conjunctival anemic and palpable contractions of soft uterine contractions. The patient's condition is in accordance with the manifestation of grade III blood loss. The anesthesiology diagnosis is a 25-year-old woman with Postpartum hemorrhage et causa Atonic Bleeding of Uterine on P3A0H3 post SCTP Outside Dr. Moewardi Hospital + Hypovolemic Shock pro Emergency Laparotomy until Total Abdominal Hysterectomy with Physical Status ASA IVE Plan with RSI general anesthesia Control.</p><p>Intraoperative Management of anesthesia uses RSI's general anesthesia technique to control hemodynamics and uses anesthesia drugs that do not worsen the patient's condition. At the time of surgery, we did the transfusion because there was a significant amount of bleeding during the procedure and was categorized as Class IV bleeding.</p><p>Anesthesia care of patients with postpartum hemorrhage extends from the antenatal period to the postpartum period. Optimal postpartum hemorrhage management occurs when nurses, obstetricians and anesthesiologists recognize early the potential for excessive bleeding and trigger a 'major obstetric hemorrhage protocol' that describes specific tasks for each team player and the algorithm that must be followed according to etiology, circumstances and time during labor.</p>

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