Anesthesia for GIT Surgery and Hemorrhoidectomy

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Questions and Answers

What type of medication is given prior to surgery on the anal canal to reduce adverse effects of stimulation?

A potent analgesic, such as Fentanyl or Alfentanil

Why is close monitoring of the ECG important during surgery on the anal canal?

Because of the possibility of arrhythmias

Why is urinary catheterization generally recommended in the postoperative period?

To prevent retention of urine due to reflex spasm of the urinary bladder caused by severe pain, fear, and anxiety

What are some potential complications of surgery on piles?

Pain, retention of urine, hemorrhage, and formation of fistula Signup and view all the answers

What is a fistula?

An abnormal or surgically made passage or connection between a hollow or tubular organ and the body surface, or between two hollow or tubular organs Signup and view all the answers

What is the procedure called to remove a fistula?

Fistulotomy Signup and view all the answers

What is the main cause of hemorrhoids?

Severe cases of constipation, which leads to repeated straining while having a bowel motion Signup and view all the answers

What are the two types of hemorrhoids?

Internal hemorrhoids and external hemorrhoids Signup and view all the answers

What are the common symptoms of hemorrhoids?

Itching, pain, and bleeding during defecation Signup and view all the answers

What is the conservative treatment for hemorrhoids?

Eating high fiber foods, using topical treatment, and taking oral pain killers Signup and view all the answers

What is the surgical procedure for removing hemorrhoids?

Hemorrhoidectomy Signup and view all the answers

When is hemorrhoidectomy indicated?

When conservative treatment has failed, or when internal hemorrhoids are large and prolapsing Signup and view all the answers

What is the standard operation technique for hemorrhoidectomy?

Excision and ligation technique Signup and view all the answers

What is the required patient position for hemorrhoidectomy?

Lithotomy position with Trendelenburg’s tilt Signup and view all the answers

What is the typical age range of patients affected by the condition?

40-70 years old Signup and view all the answers

What is the primary indication for palliative treatment during pregnancy?

Antibiotic and analgesic treatment Signup and view all the answers

What additional investigation is necessary for younger, asymptomatic patients before surgery?

Full blood count to eliminate the possibility of anemia Signup and view all the answers

What type of medication is typically used for premedication in this procedure?

Anxiolytic, such as a Benzodiazepine Signup and view all the answers

What is the primary advantage of regional anesthesia in this procedure?

It avoids general anesthesia Signup and view all the answers

What type of spinal anesthesia is commonly used in this procedure?

Saddle block using Bupivacaine or Lidocaine Signup and view all the answers

What is the primary purpose of using an endotracheal tube in general anesthesia?

To protect the airway from regurgitation and/or laryngeal spasm Signup and view all the answers

What positioning is recommended for patients with an endotracheal tube?

Head tilted downward Signup and view all the answers

Study Notes

Hemorrhoids

Hemorrhoids, also known as piles, are abnormally swollen, dilated, engorged, enlarged, or inflamed veins in the anus and lower rectum.
Causes: severe cases of constipation with repeated straining, leading to pooling of blood and enlargement of veins in the area.
Symptoms: itching, pain, bleeding during defecation.
Can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).

Treatment

Conservative and medical treatment: eat high fiber foods, apply topical treatments, soak in warm water, and take oral painkillers.
Surgical excision of hemorrhoids (hemorrhoidectomy) is indicated when conservative treatment fails or internal hemorrhoids are large and prolapsing.

Hemorrhoidectomy

Standard operation: excision and ligation technique.
Requires: lithotomy position with Trendelenburg's tilt, good relaxation of the anal sphincter.

Patient Characteristics

Any adult can be affected, but typically: 40-70 years old, with various disorders associated with aging, and possibly pregnant.
ASA grades 1-4.

Preoperative Assessment

Symptomatic patients with chronic disease need preoperative investigations.
Younger, asymptomatic patients need only a full blood count to eliminate the possibility of anemia due to bleeding.

Premedication

Anxiolytic, such as a Benzodiazepine, is normally adequate for this procedure.

Perioperative Management

Surgery in the anus region causes severe pain and precipitates adverse responses, such as reflex laryngeal spasm, arrhythmias, and reflex movement.
The patient needs adequate anesthesia with good muscle relaxation.

Anesthetic Technique

Regional anesthesia: frequently the method of choice, avoids general anesthesia, provides good postoperative analgesia, and attenuates the stress response.
Spinal anesthesia (saddle block) produces adequate analgesia, best performed in the sitting position using Bupivacaine or Lidocaine.
General anesthesia: deep general anesthesia obtained by face mask, laryngeal mask airway (LMA), endotracheal tube, or potent analgesic (Opioid-Fentanyl or Alfentanil).

Postoperative Management

Pain can be intense in the early postoperative period, and good doses of opioids can be used for the first 48 hours.
Retention of urine (reflex spasm of urinary bladder due to severe pain, fear, and anxiety) requires urinary catheterization.
Complications: primary hemorrhage, secondary hemorrhage, formation of a fistula, or perianal abscess.

Fistula

An abnormal or surgically made passage or connection between a hollow or tubular organ (rectum) and the body surface (skin), or between two hollow or tubular organs.
Removal of fistula is called fistulotomy.

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Description

This quiz covers anesthesia for gastrointestinal system surgery, specifically focusing on hemorrhoidectomy. It is designed for 2nd semester anesthesia students.