Benign Major Gynaecological Surgery, Fibroid Uterus, and Pelvic Masses — WACS Viva & Clinical Scenarios (Gynaecology)

Exam-style benign major gynaecological surgery, fibroid uterus, and pelvic masses viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 38-year-old nulliparous woman is scheduled for an elective abdominal myomectomy for a symptomatic 30-week sized multi-fibroid uterus. Her baseline Hb is 9.0 g/dL. The surgeon plans intra-myometrial infiltration of vasopressin. Detail your preoperative preparation, choice of anaesthesia, and anaesthetic management of potential complications.
• SCENARIO 2: A 46-year-old multiparous woman with a history of hypertension and asthma presents for total abdominal hysterectomy and bilateral salpingo-oophorectomy for symptomatic uterine enlargement and menorrhagia. Her BMI is 38 kg/m2. Formulate an anaesthetic management plan including regional vs general anaesthetic options and postoperative analgesia.
• SCENARIO 3: A 68-year-old woman with known Class II ischaemic heart disease and controlled diabetes mellitus is scheduled for vaginal hysterectomy and pelvic floor repair in the lithotomy position. Discuss your pre-anaesthetic evaluation, anaesthetic technique, positioning hazards, and haemodynamic monitoring plan.
• SCENARIO 4: During an open myomectomy for a giant 34-week sized fibroid uterus, 20 minutes after the surgeon injects an adrenaline/saline mixture into the uterine bed, the patient suddenly develops ventricular tachycardia with a pulse, followed by severe pulmonary oedema. Outline your immediate diagnostic approach and resuscitative management.