| Preoperative | Intraoperative | Postoperative |
| | | - Thromboembolism prophylaxis
|
- Smoking cessation four weeks preoperatively
| - Standardized ventilation strategy
| - Extended chemoprophylaxis for patients with laparotomy for abdominal or pelvic malignancy
|
- Alcohol cessation four weeks preoperatively as indicated
| - Postoperative nausea and vomiting prophylaxis
| - Maintenance of normovolemia: Discontinue IV fluids within 24 hours postoperatively
|
- Avoidance of mechanical bowel preparation preoperatively
| - Minimally invasive surgery when appropriate and available
| - Initiation of a regular diet within the first 24 hours postoperatively
|
- Ingestion of clear fluids up to two hours prior to anesthetic induction
| - Avoid routine nasogastric intubation; remove at end of procedure if used
| - Consider use of postoperative laxatives and chewing gum
|
- Ingestion of solids up to six hours prior to anesthetic induction
| - Maintain normothermia with warming device
| - Maintain normal blood glucose levels, treat hyperglycemia, avoid hypoglycemia
|
- Carbohydrate loading preoperatively
| - Maintain euvolemia: Avoid very restrictive or liberal fluid regimens
| - Multimodal postoperative analgesia, including NSAIDs, acetaminophen, gabapentin, and dexamethasone, unless contraindicated
|
- Avoidance of routine preoperative sedative use
| | - For open general gynecologic surgery, consider a transversus abdominis plane block (TAP block) or surgical site infiltration, in combination with nonopioid analgesic agents
|
- Cessation of oral contraception prior to surgery
| | - For laparoscopic general gynecologic or gynecologic oncologic surgery, a multimodal approach should be employed
|
| | | - Avoid routine intraperitoneal drain placement
|
| | | - Discontinue urinary catheters for postoperative bladder drainage by 24 hours postoperatively
|
- Chlorhexidine-alcohol for skin preparation
| | - Mobilize early, within 24 hours of surgery
|
- For gynecologic oncology, consider placement of TEA, but additional IV opioids may be required
| | |
