This document discusses case selection and anesthesia considerations for tubal ligation procedures. It outlines eligibility criteria according to WHO categories, including categories that require extra precaution, procedures that should be delayed, and those needing special precautions or referral. Local anesthesia is preferred but general anesthesia may be necessary in some situations like an uncooperative patient, excessive obesity, or allergy to local anesthetics. Requirements for safe administration of local anesthesia and drugs available for general anesthesia are also mentioned.

1. SELECTION OF CASES AND ANAESTHESIA IN
TUBECTOMY
-AKSHAY .B.K.
11M2303

2. Case Selection
(Self-declaration by the client will be the basis for compiling this information.)
• Clients should be married .
• Clients should be below the age of 49 years and above the age of 22 years.
• The couple should have at least one child whose age is above one year unless the
sterilization is medically indicated.
• Clients or their spouses/partners must not have undergone sterilization in the past (not
applicable in cases of failure of previous sterilization).
• Clients must be in a sound state of mind so as to understand the full implications of
sterilization.
• Mentally ill clients must be certified by a psychiatrist, and a statement should be given
by the legal guardian/spouse regarding the soundness of the client’s state of mind.

3. WHO ELIGIBILITY CRITERIA:
CATEGORY C: (extra caution)
• Young age .
• Obesity.
• Hypertension .
• IHD, Cardiovascular diseases.
• Uterine fibroids.
• Past PID.
• Hypothyroidism.
• Liver tumours.
• Thalassemia, sickle cell disease.
• Kidney disorders.
• Depressive disorders.
• Previous abdominal or pelvic surgeries.
• Severe nutritional deficiencies.

4. CATEGORY D: (delay procedure)
• Pregnancy.
• Postpartum(7 to < 42 days).
• Preeclampsia/ eclampsia.
• Puerperal sepsis.
• Severe APH or PPH.
• Unexplained vaginal bleeding before evaluation.
• Malignant gestational trophoblastic disease.
• Cervical/endometrial/ovarian cancers.
• PID.
• STD’s.
• Prolonged rupture of membranes ( 24 hrs or >).
• Iron deficiency anaemia ( Hb <7g/dl).
• DVT/PE.
• Systemic infections.

5. CATEGORY S: (special precaution/refer client)
• postpartum uterine rupture /perforation.
• Post-abortion uterine perforation.
• Raised BP (sys > 160 or dia >100 mm hg).
• Endometriosis.
• Known pelvic tb.
• Diabetes with nephropathy/neuropathy/retinopathy.
• Hyperthyroidism.
• Coagulation disorders.
• Abdominal or umbilical hernia.
• Chronic lung disorders.
• AIDS.
• Complicated vascular heart diseases.

6. SELECTION OF ANAESTHESIA
• Can be done under local or spinal or general anaesthesia.
• Local anaesthesia is preferred ( conventional, mini –laparotomy ,
laparoscopic sterilization).

7. Local Anaesthesia:
• Preferred in mass camps.
• Premedication with inj. Morphine 15mg or Pethidine 100 mg with
Phenergan 50 mg IM .(30-45 min prior).
• Incisional area is infiltrated with 1% lignocaine.
• Skin sensitivity testing for local anaesthetic agent (lignocaine) .
The following are the requirements for the
administration of local anaesthesia:
• Lignocaine without adrenaline is the local anaesthetic that is to be infiltrated
on the OT table. The maximum dosage is 3 mg per kg body weight.
• Client must be monitored and attended to after the parenteral
administration.
• Communication must be maintained with the client throughout the
procedure.

8. General Anaesthesia (rarely necessary)
However, it may be required in the following conditions:
• In case of a non-cooperative patient.
• In case of excessive obesity.
• In case of a history of allergy to local anaesthetic drugs.
The following drugs may be made available for the
GA cases :
• Injection Thiopentone Sodium
• Injection Propofol
• Injection Morphine
• Injection Pethidine
• Injection Neostigmine
• Injection Terbutaline
• Injection Ondansetron
• Injection Nitroglycerin.

9. Thank you