Perioperative Care, Anesthesia, and Surgical Safety
Preoperative optimization
Assess comorbidities, medications (anticoagulants), nutrition, and functional status. Bowel prep and antibiotic prophylaxis per guidelines. Venous thromboembolism (VTE) risk stratification and prophylaxis. Optimize glucose control and smoking cessation. Discuss anesthesia options: general, regional (spinal/epidural), or local with sedation.
Intraoperative and postoperative safety
Positioning to avoid nerve injury (brachial plexus, common peroneal). Maintain normothermia, glycemia, and fluid balance. Enhanced recovery pathways reduce length of stay. Postoperative monitoring for urinary retention, ileus, infection, and VTE. Early ambulation.
Traps
- Forgetting VTE prophylaxis in high-risk patients.
- Missing anticoagulation reversal or bridging plans.
- Overlooking positioning nerve injuries (lithotomy, prolonged surgery).
- Assuming regional anesthesia eliminates VTE risk.
- Failing to monitor PVR after incontinence/prolapse surgery.
Rule of thumb
Use a checklist and risk stratification: VTE risk, antibiotic timing, positioning, and PVR monitoring. Enhanced recovery protocols improve outcomes without compromising safety.