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Daniel L. Clarke-Pearson Emily Ko Lisa Abaid Kevin Schuler
The preoperative evaluation should be complete and thorough, taking into account the essential aspects of the patient’s general medical condition and prior surgical history. The risks, benefits, and potential complications of the surgical procedure should be discussed with the patient, including the most frequent complications of the particular surgical procedure. Alternative management, if any, should be presented.
A calculated body mass index (BMI) can be used as a surrogate marker for nutritional status.
Careful and meticulous ﬂuid and electrolyte management is essential for all patients undergoing major surgical procedures.
Although satisfactory analgesia is easily achievable with available methods, patients continue to suffer unnecessarily from postoperative pain.
Prophylactic antibiotics should be employed judiciously. Prompt identification of perioperative infections and their specific treatments are critical to minimize the impact of this common morbidity.
Early in the clinical course, a postoperative small bowel obstruction may exhibit signs and symptoms identical to those of ileus. Initial conservative management as outlined for the treatment of ileus is appropriate.
Because pulmonary embolism is the leading cause of death following gynecologic surgical procedures, the use of prophylactic venous thromboembolism regimens is an essential part of management. In patients at moderate risk, intermittent pneumatic compression (IPC) during and after gynecologic surgery reduces the incidence of deep venous thrombosis on a level similar to that of low-dose or low molecular weight heparin. A combination of mechanical (IPC) and pharmacologic prophylaxis is recommended for high-risk patients.
Patients who are predisposed to cardiovascular, respiratory, and endocrine illnesses must be thoroughly evaluated preoperatively. Coronary artery disease and chronic obstructive pulmonary disease (COPD) are major risk factors for patients undergoing abdominal surgery. Patients with hypertension should receive medication to control their blood pressure before surgery. Perioperative management of medical complications must be prompt and meticulous.
The successful outcome of gynecologic surgery is based on thorough evaluation, careful preoperative preparation, and attentive postoperative care. This chapter discusses approaches to the general perioperative management of patients undergoing major gynecologic surgery with specific medical problems that could complicate the surgical outcome.
Gynecologic surgery should be undertaken only after gaining a thorough understanding of a patient’s medical history and performing a complete physical examination.
1.