Many women get uterine fibroids, noncancerous growths in the uterus that develop in the childbearing years. If you require surgery to remove fibroids, you'll likely be given general anesthesia and will be asleep during the procedure.
Anesthesiologists work alongside the surgeons who remove uterine fibroids, monitoring you closely. “Here, we have highly trained physicians and a team of anesthesiologists who specialize in gynecologic procedures. We are prepared to ensure your safety and comfort,” says Yale Medicine's gynecologic anesthesia specialist Philip Rubin, MD.
What are the options for anesthesia for uterine fibroid surgery?
Surgery for uterine fibroids can be performed through a single abdominal incision; through tiny, laparoscopic incisions; or through the vagina. General anesthesia is usually recommended for any of these surgeries. This allows the patient to be in a deep sleep throughout the procedure and not feel any pain or discomfort. It also allows for a quicker recovery.
If a patient strongly opposes general anesthesia (and is not undergoing a laparoscopic procedure), or if another health problem makes it too risky, she may have the option of receiving a spinal anesthetic—similar to what women are given for caesarean section—or deep sedation, instead. “We do have that option for gynecologic surgeries, although it may prolong the patient’s hospital stay,” says Dr. Rubin.
Spinals numb the legs and take several hours to wear off, so patients must stay in the recovery room for a longer period of time.
Another type of treatment for uterine fibroids, called embolization, involves threading a tiny wire through an artery leading to the uterus. Embolization may be a good choice for women who don’t want to have any more children, but who don’t want an invasive surgery such as a hysterectomy. For this procedure, patients are usually kept awake. They’re given local anesthetic to numb the injection site and a sedative to make them drowsy.
How are uterine fibroid patients prepared for general anesthesia?
A woman planning fibroid surgery usually meets her anesthesiologist about 30 minutes before her scheduled procedure. Typically the anesthesiologist has already reviewed her case and spoken with her doctor ahead of time.
“Even though we’re just meeting the patient for the first time, we already know a lot about her,” Dr. Rubin says. “We use this time to do a physical exam and discuss with her the options she has for anesthesia.”
The anesthesiologist also discusses the potential risks associated with being put to sleep, such as nausea, vomiting and headache upon awakening. Patients can elect to receive medications for nausea and for pain after surgery as part of their treatment plan.
A patient may also receive an intravenous drug called midazolam before surgery, which makes her feel drowsy and relaxed. She usually receives this medication after walking back to the operating room. “If a patient tells me she’s really anxious or that her heart is racing, we’ll administer it ahead of time and take her back to the operating room in a wheelchair or on a stretcher,” Dr. Rubin says.
How does general anesthesia for fibroid surgery work?
For general anesthesia, a patient is usually given propofol through an I.V. While she’s being put to sleep, an oxygen mask is placed over her nose and mouth to assist her breathing. “The next thing she knows, the surgery is over,” Dr. Rubin says. “She wakes up and says, ‘When are we starting?’”
The anesthetic medications are given continuously throughout the surgery to ensure that patients stay asleep. An anesthetic provider is present the entire time to monitor the patient’s anesthetic, breathing and vital signs. Once the procedure is complete, the anesthetic is discontinued, and the patient wakes up soon after in the operating room.
It usually takes about an hour in the recovery room—under the watch of a team of anesthesiologists and nurses—for the patient to fully recover. For most uterine fibroid procedures, patients do not have to stay overnight, but they must have someone else drive them home if they had general anesthesia. “Even if you feel fully awake, your judgment could still be temporarily impaired,” Dr. Rubin says.
What are the risks of general anesthesia for fibroid surgery?
Anesthetic medications can cause postoperative nausea and vomiting, especially when used for gynecologic procedures. In an attempt to prevent these side effects, anti-nausea medicines are always given to fibroid patients through the I.V. toward the end of surgery.
In any surgery, there is always a risk of blood loss, so anesthesiologists talk to patients about this possibility, Dr. Rubin says. “But because fibroids aren’t typically very vascular, there is a really low risk of excess bleeding.”
Patients going under general anesthesia are often worried about waking up during surgery—or not waking up at all. Anesthesiologists try to ease those fears, Dr. Rubin says. “Anesthesia is very, very, very safe,” he says. “You’re monitored the entire time during your surgery, and prolonged sedation is rare in women who undergo fibroid surgery.”
What is unique about Yale Medicine’s approach to anesthesiology for uterine fibroid surgery?
Patients can take comfort in the fact that every member of their surgical and anesthesiology team is an expert in their field. “While fibroid surgery is done on an outpatient basis, more advanced resources are much more limited in outpatient centers,” Dr. Rubin says.
Yale Medicine's has highly trained physicians and anesthesiologists who specialize in gynecologic procedures, so patients should feel safe and comfortable before, after and during their surgery, he says.