Powell L, Garfield J M
Department of Anesthesia, Harvard Medical School, Boston, Massachusetts.
Semin Surg Oncol. 1990;6(3):194-8. doi: 10.1002/ssu.2980060312.
Preoperative, intraoperative, and postoperative anesthetic considerations in gynecologic cancer surgery are discussed. Preoperatively, the anesthetist must document the patient's disease state, physical condition, responses to prior chemotherapeutic regimens and toxic side effects, particularly from Adriamycin and bleomycin. Laboratory studies should include electrolytes, hepatic, renal, and hematologic indices. The anesthetist should also recognize that patients may be under great emotional stress, which may require prescribing anti-anxiety medications for several days prior to surgery. Planning the anesthetic includes consultation with the surgeon relative to procedure planned, positioning requirements, anticipated blood loss, monitoring and postoperative care requirements. Intraoperative considerations again involve close communication with the surgeon. The use and benefits of a combined regional/general anesthetic technique are discussed. Postoperative considerations are directed toward hemodynamic stability and control of postoperative pain. Techniques of epidural narcotic and local anesthetic administration, as well as patient-controlled analgesia (PCA) are discussed.
本文讨论了妇科癌症手术术前、术中和术后的麻醉注意事项。术前，麻醉医生必须记录患者的疾病状态、身体状况、对先前化疗方案的反应以及毒性副作用，尤其是来自阿霉素和博来霉素的副作用。实验室检查应包括电解质、肝、肾和血液学指标。麻醉医生还应认识到患者可能承受巨大的情绪压力，这可能需要在手术前几天开抗焦虑药物。麻醉计划包括与外科医生就计划的手术、体位要求、预计失血量、监测和术后护理要求进行会诊。术中注意事项再次涉及与外科医生的密切沟通。讨论了联合区域/全身麻醉技术的使用和益处。术后注意事项针对血流动力学稳定性和术后疼痛控制。讨论了硬膜外麻醉和局部麻醉给药技术以及患者自控镇痛（PCA）。
