1. Dr Edward Sang, Fellow, Gynaecologic Oncology
Preoperative care
Dr Edward Sang,
Fellow, Gynaecologic Oncology

2. 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

3. Definitions Assessment Diagnosis Correct decision for surgery
Patient appraisal: options
Pre-op evaluation and preparation

4. 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

5. 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

6. Important aspects
History and physical examination

7. Important aspects Lab tests and imaging Avoid routine tests
Consultations

8. 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

9. 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

10. 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

11. 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?

12. 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

13. 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

14. Physical examination Start with complete physical examination
Breast examination
Abdominalexamination
Pelvic and rectal examination

15. Laboratory assessment/tests
FBC
Uec
Glucose
ECG

16. 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

17. 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