Transcript Preoperative care

Dr Edward Sang,
Fellow, Gynaecologic Oncology
Definitions
 Preoperative care: the patient management period
during which time gynaecologic pathology, defects
and injury are assessed and diagnosed; an accurate
decision is made for a surgical intervention; the
patient is appropriately appraised of the problem and
need for surgery as well as options available; and
necessary preoperative evaluation and preparation is
accomplished
Definitions
 Assessment
 Diagnosis
 Correct decision for surgery
 Patient appraisal: options
 Pre-op evaluation and preparation
Definitions
 Preoperative evaluation: the assessment of a patient
before surgery to detect factors that could affect
surgical outcome and may include physical
examination, laboratory testing, imaging and
consultations
Introduction
 The preoperative care and management of women has
proven to be a critical factor in achieving successful
outcomes of both emergent and scheduled
gynaecological surgical procedures
Important aspects
 History and physical examination
Important aspects
 Lab tests and imaging
 Avoid routine tests
 Consultations
Introduction
 Minimal preoperative testing for the uncomplicated
patient and specific testing and imaging for the
complicated case
 Each patient must be considered as an individual
Importance of preoperative care
 Successful surgical outcomes in operative
gynaecological procedures occur as a result of several
factors which include:
 Appropriate preoperative evaluation
 Appropriate patient selection
 Appropriate discussion with the patient regarding
benefits and risks of the surgery
 Costs/ medical aid
Purpose of preoperative evaluation
 Decrease surgical morbidity
 Minimize expensive delays and cancellations on the
day of surgery
 Evaluate and optimize patient health status
 Facilitate the planning of anaesthesia and
perioperative care
 Reduce patient anxiety through education
 Obtain informed consent
Important questions
 Is the patient in optimal health?
 Can, or should, the patient’s physical or mental
condition be improved before surgery?
 Does the patient have health problems or use any
medications that could unexpectedly influence
perioperative events?
History
 History best taken by the surgeon
 To determine best procedure and timing
 Avoids unnecessary surgery
 Pre-printed forms or computer templates may be used.
They help avoid omissions but may not be applicable
to every case
Gynaecological history
 The menstrual history must be accurate and detailed
 Pregnancy may need to be confirmed or excluded
 Accurate date of menopause
 Pregnancy and its complications
 Urologic history
 Gastrointestinal history: symptoms may mimic gynae
problems
 Endocrine and metabolic diseases
 Orthopaedic and neurologic history
Physical examination
 Start with complete physical examination
 Breast examination
 Abdominalexamination
 Pelvic and rectal examination
Laboratory assessment/tests
 FBC
 Uec
 Glucose
 ECG
Preop preparation
 Ovarian suppression with GnRHa 2-3m before
hysteroscopic resection of submucous fibroids
 Vaginal oestrogen cream 4-6w before surgery to
thicken vaginal mucosa
 Regulation of meds eg Insulin, warfarin
 When to admit: usually day of surgery
 Food intake: no evening meal on day before surgery
 ? Bowel prep. Recent evidence advises avoid
Preop preparation
 A good nights’ rest. Consider mild sedative
 Preop antibiotics
 Pubic or abdominal hair clipping
 Catheterization
 EUA
 Perineum and vaginal cleansing
 Abdominal preparation-povidone iodine