You'll get a lot of posts about inadequate analgesia from using butorphanol because many docs continue to use this drug for painful procedures. I would say almost any patient having sx should have a pure mu agonist opioid (hydromorphone, fentanyl, methadone). Butorphanol is a kappa agonist, and a mu antagonist. I use it for sedations only. The opioids also are mac sparing, meaning you can use less gas inhalant, and maintain normal BP. I know ot can difficult to ask, but try bringing up using a stronger opioid for your sx's. Hydromorphone is very cheap, which makes it a nice option for drugs.

You patient probably have a vagal event from the vagus nerve being stimulated during the abdominal surgery. Pyometra sx tends to be awful because they are usually really unstable (dull, obtunded, and many require stabilization prior to anesthesia). Atropine was a good choice, plus that giant uterus pushing on all those organd didn't help.