Perioperative Care
What the exam tests
This domain covers preoperative assessment, fasting, VTE prevention, antibiotic prophylaxis, enhanced recovery, fluid therapy and recognition of postoperative complications.
Core rules
- Use the WHO surgical safety checklist, including sign-in, time-out and sign-out.
- Fasting is usually six hours for solids and two hours for clear fluids; prolonged fasting is unnecessary and harmful.
- Assess VTE risk and prescribe mechanical and pharmacological prophylaxis unless contraindicated.
- Give antibiotic prophylaxis within 60 minutes before incision according to local policy; avoid routine postoperative antibiotics.
- Enhanced recovery principles include carbohydrate loading, normothermia, opioid-sparing analgesia, restrictive fluids and early feeding and mobilisation.
Worked example
A 75-year-old with a hip fracture is assessed for surgery. Analgesia, fluid status and comorbidity are optimised; VTE prophylaxis and antibiotic prophylaxis are prescribed. Surgery proceeds without unnecessary delay, and a delirium screen, early mobilisation and multimodal analgesia are included in the postoperative plan.
Traps
Prolonged fasting without indication; omitting VTE prophylaxis; stopping beta-blockers abruptly; missing postoperative urinary retention; and attributing postoperative confusion to age rather than assessing pain, infection, hypoxia or drugs.