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FAQ
Importance and process of preoperative preparation
Taizhou Hospital Linhai Campus Surgical Surgery Instructions
Prevention and control of surgical site infection
Perioperative patient care
Preoperative preparation for minimally invasive gynecological surgery includes multiple steps to ensure the smooth progress of the operation and reduce postoperative complications. The following are detailed preoperative preparation steps:
Patient preparation:
Patients need to maintain personal hygiene, take a bath and wash their hair before surgery.
No eating or drinking for 6 hours before surgery, no drinking for 2 hours before surgery.
Empty the bladder and place a catheter if necessary.
Quit smoking and drinking, and avoid using drugs that affect blood coagulation (such as aspirin, warfarin, etc.).
Psychological preparation:
Medical staff should provide preoperative counseling to patients, explain the reasons, process and possible complications of the operation, relieve the patient's tension, and obtain the patient's understanding and consent.
Physical examination and history collection:
Perform a full physical examination, especially heart, liver, lung, and kidney function tests, to rule out serious medical diseases and contraindications.
Perform gynecological examination and routine examination secretions, and measure blood pressure, pulse, and body temperature.
Instrument preparation:
Prepare the corresponding surgical instruments, such as sterile gloves, masks, hats, sutures, needles, gauze strips, etc.
Check and debug special instruments, such as hysteroscopic electrosurgical equipment, B-ultrasound equipment, etc.
Skin preparation:
Clean the skin one day before surgery and shave the body hair near the incision.
Use surgical soap to wash the abdomen and navel.
Disinfection work:
Disinfect the vulva. The principle is to disinfect the labia minora and labia majora symmetrically from the inside to the outside, from top to bottom, and then disinfect the upper 2/3 of the inner thigh.
Use alcohol or other alcohol-containing disinfectants for skin disinfection.
Anesthesia preparation:
Choose the appropriate anesthesia method according to the type of surgery, such as local anesthesia or general anesthesia, and make preparations for anesthesia before surgery.
The above detailed preoperative preparations can create favorable conditions for minimally invasive gynecological surgery, promote wound healing, and reduce the risk of postoperative complications.
In minimally invasive gynecological surgery, choosing the safest and most effective anesthesia method requires comprehensive consideration of the patient's specific conditions, the type of surgery, and time. The following anesthesia methods are recommended as safe and effective:
Monitored anesthetic management (MAC) or general anesthesia:
This method is suitable for hysteroscopic surgery, which can reduce pain and discomfort during surgery and improve patient comfort.
General anesthesia usually uses anesthetic drugs with fast onset, fast elimination, and low liver and kidney toxicity, such as propofol, etomidate, etc.
Local infiltration anesthesia:
It is suitable for some small-scale operations, such as local infiltration plus esketamine anesthesia in painless abortion surgery.
Esketamine has obvious analgesic and sedative effects, which can significantly improve the sedative effect and shorten the awakening time.
Intraneural anesthesia:
Intraneural anesthesia is the preferred anesthesia method for obstetric surgery, but it is not suitable for parturients with bleeding tendency, spinal deformity, puncture site infection, etc.
For other types of minimally invasive gynecological surgery, intraneural anesthesia may be limited due to the long recovery time.
New short-acting sedatives:
Remimazolam is a new short-acting sedative with rapid onset and rapid recovery of consciousness, suitable for anesthesia in outpatient diagnosis and treatment.
The combination of dexmedetomidine and propofol can significantly improve the sedative, hypnotic and anti-anxiety effects, and wake up faster and have more stable blood oxygen saturation.
Nonsteroidal anti-inflammatory drugs (NSAIDs):
In painless abortion surgery, NSAIDs can be used to relieve postoperative uterine contraction pain with fewer side effects.
Ropivacaine:
Ropivacaine is widely used in preoperative anesthesia in obstetrics and gynecology due to its obvious anesthetic effect, which can ensure the smooth progress of the operation.
In summary, for most minimally invasive gynecological surgeries, it is recommended to use monitored anesthesia management (MAC) or general anesthesia, combined with short-acting sedatives such as propofol, etomidate, etc. Local infiltration anesthesia and new short-acting sedatives such as remimazolam and dexmedetomidine are also suitable for surgery in specific circumstances.
To properly disinfect the skin before gynecological surgery to reduce the risk of infection, a series of detailed steps and precautions need to be followed. The following are specific operating guidelines:
Preoperative preparation:
The patient should bathe with antibacterial soap and change clothes or take a local sponge bath one day or earlier before surgery.
If conditions permit, bathe with a disinfectant containing chlorhexidine 2-3 days in advance.
Skin cleaning:
Rinse the whole body with soapy water or disinfectants to ensure skin cleanliness.
For patients undergoing organ transplant surgery and severe immunosuppression, the skin of the whole body can be wiped and washed with antibacterial soap before surgery.
Disinfection method:
Use iodine soap cotton balls to scrub the perineum and, cut pubic hair, and rinse the vulva.
For patients involved in hysterectomy surgery, 4% chlorhexidine gluconate or povidone iodine should be used to disinfect the.
Use a sterile cotton ball soaked in iodine disinfectant stock solution or other alternative items to wipe the local area twice, or use iodine tincture stock solution to directly apply to the skin surface, wait for it to dry slightly, and then use 70%-80% ethanol to deiodine.
If pathogenic microorganisms contaminate the skin, it needs to be thoroughly rinsed. It can be wiped and disinfected with iodine-attached stock solution, ethanol, isopropyl alcohol and chlorhexidine-prepared disinfectant for 3-5 minutes.
Disinfection range:
The disinfection range should be wiped from the inside to the outside of the surgical field and the area more than 10 cm outside.
If you need to extend the incision, make a new incision or place a drainage, the disinfection range should be expanded.
Special precautions:
Avoid pulling hair at the surgical site unless there are contraindications. If hair must be pulled, it should be pulled immediately before surgery. It is best to use an electric shaver or use hair removal products after testing skin irritation.
When skin preparation is performed on the day of surgery, if it is necessary to remove hair at the surgical site, a method that does not damage the skin should be used to avoid shaving hair with a blade.
Postoperative care:
In addition to the corresponding anti-infective drugs after surgery, it is recommended that patients move as soon as possible and pay attention to psychological intervention.
For patients with hypertension and diabetes, special attention should be paid to the following points in preoperative preparation:
Blood pressure management:
Patients with hypertension should be monitored dynamically before surgery, and the dosage of antihypertensive drugs should be adjusted according to relevant guidelines to ensure stable blood pressure
.
For patients with severe complications of hypertension (such as heart failure), blood pressure should be controlled below 160/100 mmHg, and surgery can only be considered after the condition stabilizes
.
Blood sugar management:
Patients with diabetes need to strictly control blood sugar levels. Preoperative fasting blood sugar should be controlled below 8 mmol/L, and insulin or glucose infusion should be performed if necessary
.
For patients using SGLT2 inhibitors, it is recommended to stop using them within 24-48 hours before surgery to avoid complications of hyperglycemia after surgery
.
If the patient usually uses long-acting hypoglycemic drugs, they should stop taking them 2-3 days before surgery; if insulin is used, it should be stopped the morning before surgery
.
Nutrition and metabolic management:
Anemia patients should supplement iron through diet (such as green leafy vegetables, meat and nuts), as well as vitamin B12 and folic acid to improve anemia and reduce the chance of blood transfusion.
For patients with hypoproteinemia, intravenous albumin supplementation can be used to improve their tolerance.
Management of other special conditions:
Preoperative treatment and care should be strengthened to improve the patient's overall health. If necessary, antibiotics or blood transfusions should be given to correct anemia, hypoproteinemia, etc.
For patients with OSAHS (obstructive sleep apnea syndrome), it is recommended to refer to relevant guidelines to monitor blood gas changes and use a ventilator at night to improve oxygen supply.
Lifestyle adjustments:
On the eve of surgery, it is crucial to maintain a proactive attitude and a healthy lifestyle. For example, quitting smoking, starting walking exercises and controlling diabetes can significantly promote postoperative recovery.
Nursing measures during the recovery period after minimally invasive gynecological surgery include the following aspects:
Wound care:
Keep the wound clean and dry, observe whether there is redness, swelling or abnormal secretions, and return for regular check-ups
Avoid using menstrual tampons irrigation to prevent retrograde infection
Diet management:
No food or water within 6 hours after surgery. If there is no discomfort, you can gradually eat liquid food, and then transition to semi-liquid and regular food, but still avoid irritating and spicy food
Intake more high-protein and high-fiber foods, avoid greasy and irritating foods, and supplement calcium to prevent osteoporosis
Activity and rest:
Getting out of bed and moving as soon as possible helps prevent deep vein thrombosis and pulmonary complications, but avoid strenuous exercise and lifting heavy objects
Bedridden patients should perform limb activities in bed, gradually increase the amount of activity, and participate in self-care
Pain management:
Give painkillers according to doctor's orders, assess the patient's pain, and perform painless care and drug analgesic intervention
Urinary management:
Keep the catheter and abdominal drainage tube unobstructed, and monitor the nature and amount of drainage fluid in time. The drainage tube is usually removed within 48-72 hours after surgery, and the urinary catheter is removed 7-14 days after surgery.
Start clamping the catheter 3 days before the removal of the catheter and open it every 2 hours to train the bladder function and restore normal urination ability.
Psychological support and education:
Nurses should encourage patients and their families to actively participate in the formulation of discharge plans and ensure the feasibility of the plans.
Explain the postoperative lifestyle guidance to the patient, including gradually increasing the amount and intensity of activities according to the body's recovery, appropriately participating in social activities or resuming daily work.
Follow-up and reexamination:
The first follow-up is conducted 1 month after discharge, and reexamination is conducted every 3 months within 2 years after treatment, every 6 months within 3-5 years, and once a year starting from the 6th year.
Follow-up visits include pelvic examination, smear cytology, high-risk HPV testing, chest X-ray, blood routine and cervical squamous cell carcinoma antigen (SCCA), etc.
Other precautions:
Pay attention to bowel and urinary habits, avoid constipation and straining to defecate, and eat more high-fiber foods
Maintain a correct standing posture, keep your chest and hips up, avoid heavy lifting, pushing and pulling, limit strenuous activities, and take appropriate rest and walk
Assessing and managing the risk of preoperative complications in minimally invasive gynecological surgery is a complex and multifaceted process. The following are detailed steps and measures:
1. Preoperative preparation and risk assessment
1.1 Patient education and informed consent
The doctor should explain the reasons, process and possible complications of the operation to the patient in detail, and ensure that the patient fully understands and signs the consent form
1.2 Medical history and drug management
The patient needs to inform the doctor of his or her past medical history, previous surgeries, recent medications and possible complications
In addition, maintaining personal hygiene can prevent wound infection.
1.3 Identification of high-risk factors
High-risk factors include age, uterine position, presence or absence of polyps or submucosal fibroids in the uterine cervix, etc.
These factors need to be evaluated in detail before surgery so that corresponding preventive measures can be taken.
2. Comprehensive nursing intervention before surgery
2.1 Psychological support
Giving psychological support to patients before surgery to gain their trust and reduce tension and anxiety plays an important role in improving surgical results and prognosis
.
2.2 Drug management
For some drugs (such as misoprostol), although they can dilate the cervix to the optimal degree, they increase the risk of complications, so they are not recommended before HSC surgery
.
3. Monitoring and prevention during surgery
3.1 Vital sign monitoring
Closely observe the patient's vital signs during surgery, such as blood pressure, pulse, respiration and body temperature, and promptly detect and deal with abnormal conditions
.
3.2 Technical operation specifications
Strictly abide by the surgical operation specifications to avoid complications such as uterine perforation and bleeding caused by excessive fatigue and improper operation
.
4. Postoperative care and complication prevention
4.1 Postoperative care
On the first day after surgery, closely observe the patient's vital signs to prevent complications
. After surgery, patients should be instructed to perform deep breathing exercises and light leg exercises to prevent deep vein thrombosis and pulmonary embolism
.
4.2 Cleaning and disinfection
Keep the wound clean and dry, check regularly, and avoid infection
.
5. Long-term follow-up and management
5.1 Long-term follow-up
Contact the patient within three months after discharge, guide him to gradually increase his exercise, and arrange a follow-up examination
.
5.2 Complication management
If serious complications occur (such as damage to nearby organs, severe bleeding or leakage after surgery), reoperation may be required
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