Preoperative care

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Preoperative care

• Dr Edward Sang,
• Fellow, Gynaecologic Oncology

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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

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Definitions

• Assessment
• Diagnosis
• Correct decision for surgery
• Patient appraisal options
• Pre-op evaluation and preparation

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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

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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

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Important aspects

• History and physical examination

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Important aspects

• Lab tests and imaging
• Avoid routine tests
• Consultations

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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

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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

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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

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Important questions

• Is the patient in optimal health?
• Can, or should, the patients physical or mental
  condition be improved before surgery?
• Does the patient have health problems or use any
  medications that could unexpectedly influence
  perioperative events?

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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

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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

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Physical examination

• Start with complete physical examination
• Breast examination
• Abdominalexamination
• Pelvic and rectal examination

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Laboratory assessment/tests

• FBC
• Uec
• Glucose
• ECG

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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

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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