LAPAROSCOPIC MYOMECTOMY; INSIGHTS FOR THE ANESTHESIOLOGIST

# Preoperative treatment with GnRH analogue to shrink the fibroid

# Surgeon may intraoperatively inject dilute Vasopressin ( 1 IU in 100 mL RL) to reduce bleeding. IV Vasopressin can cause raised BP, myocardial ischemia, arrhythmias etc

# Position: Dorsal lithotomy; steep Trendlenberg to move the bowel out of surgical field

# Surgical time :1-4 hours; EBL: 100-600 mL

# Complications: 

Puncture of major vessel/ severe bleeding 

Insufflation in the wrong place

Air Embolism

Need for conversion to laparotomy

Peroneal nerve damage from positioning

# Pain score : 4-6

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