Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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112 Surgery and Healing in the Developing World
Diazepam causes an acute phlebitis which can be minimized by giving the drugs
slowly (1 mg every 2 minutes). The dose of drugs depends on the clinical setting
(size of patient and history of prior drug use). In over 15 years’ use of this technique
the author has not seen a case of respiratory depression or anaphylactic reaction.
The commonest side effect is that of skin irritation.
Cervical block (10 ml of 1% or 2% lidocaine solution) is performed by direct
injection of the drug at the fifth and seventh o’clock (5th and 7th) position on the
cervix. It is important to ensure direct injection into the tissue rather than intravenously.
This can be avoided by the usual precaution of intramuscular injections,
pulling back on the plunger before injecting. Intravenous lidocaine at this dose can
lead to cardiac arrhythmia with potentially fatal consequences. The uncontrolled
diabetic with an incomplete miscarriage is a prime example for using a cervical block
alone.The cervical block is best performed after cleaning and draping the patient in
the lithotomy position.
Surgical Technique
The usual preoperative assessment for any patient is necessary in these situations.
It is helpful if the patient can have a shower prior to the procedure. This helps to
reduce the risk of infection, therefore improving the overall success of the procedure.
This is the standard set:
Medium trolley—for instruments and dilatation and curettage pack
Prep trolley—for cleaning of patient with cleansing lotions
Mini bowl set
Dilatation and curettage pack and vaginal pad
Dilatation and curettage set
Cleansing lotion– 1. Savlon
2. Normal saline
Extras—hibitane cream
Two (2) lithotomy poles
Stool for surgeon
Specimen container with formalin if necessary
Dilatation and curettage pack—sterile
One (1) pair of leggings
One (1) towel
One (1) peri-towel
Two (2) packs of gauze
One (1) vaginal pad
Dilatation and curettage set—sterile
One (1) sponge holding forceps
One (1) Auvard’s vaginal speculum
One (1) Simms vaginal speculum
One (1) metal catheter
One (1) set of uterine dilators
One (1) uterine sound
One (1) ovum forceps
Two (2) vulsellum
One (1) tenaculum
One (1) double-ended curette
One (1) sharp curette