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Optimizing Preanesthesia Care for the Gynecologic Patient.
Obstet Gynecol. 2019 08; 134(2):395-408.OG

Abstract

In the past, best practices for perioperative management have been based as much on dogma as science. The creation of optimized perioperative pathways, known as enhanced recovery after surgery, has been shown to simultaneously improve patient outcomes and reduce cost. In this article, we critically review interventions (and omission of interventions) that should be considered by every surgical team to optimize preanesthesia care. This includes patient education, properly managing existing medical comorbidities, optimizing nutrition, and the use of medications before incision that have been shown to reduce surgical stress, opioid requirements, and postoperative complications. Anesthetic techniques, the use of adjunct medications administered after incision, and postoperative management are beyond the scope of this review. When possible, we have relied on randomized trials, meta-analyses, and systematic reviews to support our recommendations. In some instances, we have drawn from the general and colorectal surgery literature if evidence in gynecologic surgery is limited or of poor quality. In particular, hospital systems should aim to adhere to antibiotic and thromboembolic prophylaxis for 100% of patients, the mantra, "nil by mouth after midnight" should be abandoned in favor of adopting a preoperative diet that maintains euvolemia and energy stores to optimize healing, and bowel preparation should be abandoned for patients undergoing gynecologic surgery for benign indications and minimally invasive gynecologic surgery.

Authors+Show Affiliations

Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota; the Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, Virginia; and the Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31349358

Citation

Dowdy, Sean C., et al. "Optimizing Preanesthesia Care for the Gynecologic Patient." Obstetrics and Gynecology, vol. 134, no. 2, 2019, pp. 395-408.
Dowdy SC, Kalogera E, Scott M. Optimizing Preanesthesia Care for the Gynecologic Patient. Obstet Gynecol. 2019;134(2):395-408.
Dowdy, S. C., Kalogera, E., & Scott, M. (2019). Optimizing Preanesthesia Care for the Gynecologic Patient. Obstetrics and Gynecology, 134(2), 395-408. https://doi.org/10.1097/AOG.0000000000003323
Dowdy SC, Kalogera E, Scott M. Optimizing Preanesthesia Care for the Gynecologic Patient. Obstet Gynecol. 2019;134(2):395-408. PubMed PMID: 31349358.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimizing Preanesthesia Care for the Gynecologic Patient. AU - Dowdy,Sean C, AU - Kalogera,Eleftheria, AU - Scott,Michael, PY - 2019/7/27/entrez PY - 2019/7/28/pubmed PY - 2020/3/24/medline SP - 395 EP - 408 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 134 IS - 2 N2 - In the past, best practices for perioperative management have been based as much on dogma as science. The creation of optimized perioperative pathways, known as enhanced recovery after surgery, has been shown to simultaneously improve patient outcomes and reduce cost. In this article, we critically review interventions (and omission of interventions) that should be considered by every surgical team to optimize preanesthesia care. This includes patient education, properly managing existing medical comorbidities, optimizing nutrition, and the use of medications before incision that have been shown to reduce surgical stress, opioid requirements, and postoperative complications. Anesthetic techniques, the use of adjunct medications administered after incision, and postoperative management are beyond the scope of this review. When possible, we have relied on randomized trials, meta-analyses, and systematic reviews to support our recommendations. In some instances, we have drawn from the general and colorectal surgery literature if evidence in gynecologic surgery is limited or of poor quality. In particular, hospital systems should aim to adhere to antibiotic and thromboembolic prophylaxis for 100% of patients, the mantra, "nil by mouth after midnight" should be abandoned in favor of adopting a preoperative diet that maintains euvolemia and energy stores to optimize healing, and bowel preparation should be abandoned for patients undergoing gynecologic surgery for benign indications and minimally invasive gynecologic surgery. SN - 1873-233X UR - https://www.unboundmedicine.com/medline/citation/31349358/Optimizing_Preanesthesia_Care_for_the_Gynecologic_Patient L2 - https://doi.org/10.1097/AOG.0000000000003323 DB - PRIME DP - Unbound Medicine ER -