Anesthesia Plan for Vaginal Hysterectomy

Preoperative Preparation

The American Society of Anesthesiologists recommends clear liquids be permitted up to 2 hours before procedure and solid foods avoided for 6-8 hours for patients undergoing vaginal hysterectomy 1
The American Society of Anesthesiologists suggests administering nonparticulate antacid, such as sodium citrate 30 mL, and considering adding ranitidine 50 mg IV and/or metoclopramide 10 mg IV within 60 minutes of procedure start for aspiration prophylaxis 1, 2
The American College of Obstetricians and Gynecologists recommends preemptive analgesia with acetaminophen 1000 mg PO and/or celecoxib 200-400 mg PO 1-2 hours preoperatively for patients undergoing vaginal hysterectomy 4

The American Society of Anesthesiologists recommends using a pencil-point spinal needle, such as Whitacre or Sprotte, 25-27 gauge, to minimize post-dural puncture headache risk for patients undergoing spinal anesthesia 1, 2, 5
The American Society of Anesthesiologists suggests positioning the patient sitting with back flexed to facilitate optimal distribution of hyperbaric solution during spinal anesthesia 1
The American Society of Anesthesiologists recommends identifying the L3-4 or L4-5 interspace for spinal injection and aspirating to confirm CSF flow 6

The American Society of Anesthesiologists recommends propofol conscious sedation, with a loading dose of 0.2-0.4 mg/kg and maintenance infusion of 1.5-2 mg/kg/hr, for patients undergoing vaginal hysterectomy under spinal anesthesia 6
The American Society of Anesthesiologists suggests titrating propofol to maintain conscious sedation with spontaneous ventilation, with a goal of patient responsiveness to verbal stimulation 6

The American Society of Anesthesiologists recommends standard monitoring, including continuous pulse oximetry, ECG, non-invasive blood pressure, and capnography, for patients undergoing vaginal hysterectomy under spinal anesthesia 6
The American College of Surgeons recommends maintaining IV crystalloid at 500-1000 mL during procedure to ensure euvolemic state 3
The American Society of Anesthesiologists suggests providing supplemental oxygen at 2-4 L/min via nasal cannula for patients undergoing vaginal hysterectomy under spinal anesthesia 6

The American College of Obstetricians and Gynecologists recommends a multimodal approach to postoperative analgesia, including scheduled acetaminophen 1000 mg PO/IV every 6 hours and scheduled NSAID, such as ketorolac 15-30 mg IV every 6 hours 4
The American College of Obstetricians and Gynecologists suggests using opioid rescue, such as oxycodone 5 mg PO every 4 hours PRN, for breakthrough pain (NRS >4) 4

The American Society of Anesthesiologists recommends avoiding cutting-bevel spinal needles due to increased risk of post-dural puncture headache 1, 2, 5
The American Society of Anesthesiologists suggests maintaining verbal responsiveness during propofol sedation and avoiding deep sedation or general anesthesia 6
The American Society of Anesthesiologists recommends having lipid emulsion 20% immediately available for local anesthetic systemic toxicity (LAST) and ensuring resuscitation equipment and vasopressors at bedside 6