Elective Abdominal Hysterectomy Research Articles

Prevention of Postoperative Lymphopenia and Granulocytosis by Epidural Analgesia

Blood leucocyte-counts, cortisol, and glucose were measured in twelve healthy premenopausal women undergoing elective abdominal hysterectomy during either general anaesthesia (six women) or epidural analgesia (T4 to S5) (six women). Surgery during general anaesthesia caused significant lymphopenia 6 and 9 h after skin incision and significantly increased granulocyte-counts 6, 9, and 24 h after skin incision. Epidural analgesia prevented lymphopenia and reduced granulocytosis to about 40% of that seen in the group receiving general anaesthesia. The normal increase in plasma glucose and cortisol during and after surgery was abolished by epidural analgesia. These results indicate that neurogenic stimuli from the surgical area, probably through their influence on adrenal hormones (cortisol and adrenaline), are the main mediators of postoperative lymphopenia and are partly responsible for postoperative granulocytosis. Inhibition of the endocrine-metabolic response to surgery may prevent postoperative immunodepression.

Multiple intramuscular injections: A major source of variability in analgesic response to meperidine

Meperidine (pethidine) blood concentrations following multiple intramuscular injections (100 mg) over 2 days were determined in 10 female patients undergoing elective abdominal hysterectomies or cholecystectomies. Pain was estimated by subjective bioassay and the relationship between concentration and effect determined. The blood concentration-effect curve was steep with the range from no analgesia to complete analgesia being 0.35–0.45 μg/ml on day 1 and 0.4–0.5 μg/ml on day 2. The mean (± S. D.) minimum analgesic blood concentration was 0.5 ± 0.1 μg/ml ( n = 32). Pain control was poor during the first 4-h dosing interval. The first injection postsurgery was also found to be the least representative of all subsequent injections. Blood concentrations fluctuated in phase with dosing interval, but were highly variable. Intra- and inter-patient peak concentrations varied by 2- and 5-fold and times taken to reach the peaks by 3- and 7-fold, respectively. Hence, meperidine blood concentrations were in excess of the minimum analgesic concentration for only about 35% of each 4-h dosing interval. Peak concentrations were not consistently correlated with body weight or lean tissue mass. Variable pain control following intermittent intramuscular meperidine injections was shown to be due to inadequate, fluctuating and unpredictable blood concentrations.

PREVENTION OF POSTOPERATIVE LYMPHOPENIA AND GRANULOCYTOSIS BY EPIDURAL ANALGESIA

Blood leucocyte-counts, cortisol, and glucose were measured in twelve healthy premenopausal women undergoing elective abdominal hysterectomy during either general anæsthesia (six women) or epidural analgesia (T4 to S5) (six women). Surgery during general anæsthesia caused significant lymphopenia 6 and 9 h after skin incision and significantly increased granulocyte-counts 6, 9, and 24 h after skin incision. Epidural analgesia prevented lymphopenia and reduced granulocytosis to about 40% of that seen in the group receiving general anæsthesia. The normal increase in plasma glucose and cortisol during and after surgery was abolished by epidural analgesia. These results indicate that neurogenic stimuli from the surgical area, probably through their influence on adrenal hormones (cortisol and adrenaline), are the main mediators of postoperative lymphopenia and are partly responsible for postoperative granulocytosis. Inhibition of the endocrine-metabolic response to surgery may prevent post-operative immunodepression.

A Pharmacokinetic Approach to Postoperative Pain: Continuous Infusion of Pethidine

In an attempt to improve postoperative pain management an intravenous infusion of pethidine was designed to provide stable therapeutic blood concentrations. Ten female patients undergoing elective abdominal hysterectomy were studied. After commencement of the infusion, blood pethidine concentrations increased rapidly and exceeded 0.46 microgram/ml after four hours. The mean steady-state concentration of 0.67 microgram/ml was reached by twenty-four hours. This infusion regimen resulted in the abolition of severe pain after three hours and analgesia continued for the duration of the two day study. Significant blood concentrations of the metabolite norpethidine were found although clinically no toxic effects were observed. Side effects of pethidine were infrequent. Controlled continuous intravenous infusion of pethidine produced stable blood concentrations and provided excellent pain control.

Perioperative Antibiotics in Major Elective Gynecologic Surgery

The efficacy of a three-dose, perioperative regimen of cefazolin or placebo in reducing postoperative infectious morbidity was evaluated in a double-blind study in 206 patients undergoing elective vaginal or abdominal hysterectomy. Postoperative infectious morbidity was defined as: an oral temperature of 100.4 F (38 C) or greater on any two postoperative days (excluding the first day), positive bacteriologic cultures, or pus from a wound. In premenopausal patients, cefazolin significantly reduced the incidence of postoperative infectious morbidity; 19% of the cefazolin group who had abdominal hysterectomy had evidence of infection compared to 71% of the placebo group, and 10% of the cefazolin group who had vaginal hysterectomies had evidence of infection compared to 37% of the placebo group. In postmenopausal patients undergoing abdominal hysterectomy, cefazolin also reduced the incidence of postoperative infection compared to placebo, but the difference was not significant (20% compared to 37%).

Colonic pseudo-obstruction following termination of pregnancy and uterine operation

Colonic pseudo-obstruction refers to a condition in which physical and radiologic findings identical to those associated with mechanical obstruction of the large bowel are found but in which no organic cause of the colonic distention is present. Cases of this condition have been reported in the world literature, of which 40 per cent have followed the termination of pregnancy or uterine operation. Three cases of this syndrome are presented. One followed normal vaginal delivery; one followed cesarean section, and the third followed elective abdominal hysterectomy. The literature on the subject is reviewed, and a possible anatomicophysiologic explanation, based upon a sympathetic-parasympathetic neurostimulatory imbalance, is put forward.

POSTPARTUM HYSTERECTOMY FOR STERILIZATION

Abstract Population control is of vital concern to everyone and, since many patients are seeking surgical sterilization following delivery, various forms must be immediately available. In this series, 241 patients had an elective total abdominal hysterectomy for sterilization following delivery. Of these, 108 had a cesarean hysterectomy and 133 had a postpartum hysterectomy. Morbidity was highest in the cesarean hysterectomy group and lowest when the hysterectomy was done on the third postpartum day. Ninety-five per cent of patients went home within a week of surgery, 58 per cent had no complication, and patient acceptance was high. Hysterectomy following delivery can be a beneficial proceedure from both a sterilization and a gynecologic viewpoint because many patients with gynecologic disease will require surgery in the near future and, in certain populations, follow-up care is unreliable. It is desirable for patient convenience and from an economic standpoint because only one hospitalization is required.

Prophylactic antibiotics in elective abdominal hysterectomy

In a retrospective study, morbidity was determined in 100 consecutive patients undergoing elective abdominal hysterectomies, using prophylactic oral antibiotics in conventional doses, compared with a similar nondrug group. The drugs employed were ampicillin or tetracycline. Three cases were morbid in the drug group, and 11 in the nondrug group. Average length of postoperative stay was 6.6 days in the drug group as compared to 5.7 in the nondrug series.

Postpartum hysterectomy for sterilization

Population control is of vital concern to everyone and, since many patients are seeking surgical sterilization following delivery, various forms must be immediately available. In this series, 241 patients had an elective total abdominal hysterectomy for sterilization following delivery. Of these, 108 had a cesarean hysterectomy and 133 had a postpartum hysterectomy. Morbidity was highest in the cesarean hysterectomy group and lowest when the hysterectomy was done on the third postpartum day. Ninety-five per cent of patients went home within a week of surgery, 58 per cent had no complication, and patient acceptance was high. Hysterectomy following delivery can be a beneficial proceedure from both a sterilization and a gynecologic viewpoint because many patients with gynecologic disease will require surgery in the near future and, in certain populations, follow-up care is unreliable. It is desirable for patient convenience and from an economic standpoint because only one hospitalization is required.

Human Fallopian Tube Fluid. I. Protein Composition

A method for the collection of human tubal fluid and the determination of its protein content is described. 6 patients free of adnexal disease who were scheduled for elective abdominal hysterectomy or tubal ligation were selected for the study. Tubal fluid was collected by inserting a 16-gauge polyethylene tube into each oviduct about one-third of its length from the fimbrial end at laporatomy. The proximal end of fallopian tube was ligated at the uterine cornua. The fimbrial end was sutured snugly around the tubing. The ends of the polyethylene tubes were brought out through a low transverse abdominal incision. Each was attached to a needle which in turn was inserted into a vacuotube. A sterile dressing was applied to the wound covering the tubes and changed daily. The polyethylene tubes were removed on Postoperative Day 4 or 5. Tubal fluid was collected from 4 patients. In 2 cases the fluid was either too scant or discarded because of blood contamination. Total proteins were determined by the method of Lowry. The total proteins in the tubal fluid were 3.26 gm %. Major protein fractions consisted of albumen alpha 1 alpha 2 beta 1 beta 2 and gamma-globulins with approximately the same distribution as that in serum. Immunoelectrophoretic studies revealed the presence of some 15 serum type proteins. They included isoagglutinins and immunoglobulins with the exception of IgM which was found only in trace amounts in 1 sample. A specific beta-glycoprotein apparently produced by the fallopian tube and absent in blood was detected. This protein was immunologically identical with specific ovarian tissue antigen. It is suggeseted that further studies are required to determine precisely the functional role of such a large number of proteins in human tubal fluid.

Anabolic effect of a new synthetic steroid on nitrogen metabolism after operation.

After any severe injury or major operation the rate of protein catabolism is increased. This catabolic period is usually self-limited but may be prolonged, in which case it may lead to significant protein deficiencies, particularly when the patient's appetite is poor. The nitrogen deficit attendant upon the catabolic response to injury may be alleviated to some extent by increasing the intake of protein and other foods, but this is often difficult to do. Therefore, the reversal of this catabolic response by any method, thereby permitting the organism to retain nitrogen even with a limited intake, would have important nutritional benefits. Norethandrolone (17-α-ethyl-17-hydroxynorandrostenone; Nilevar) reportedly mitigates the protein catabolic response to injury. It has been studied as a part of a research program concerned with protein repletion at the Homer G. Phillips Hospital. Method Fifteen normally nourished patients in good general health scheduled to undergo elective complete abdominal hysterectomy were studied.