Jinekolojik Cerrahide Preoperatif Değerlendirme
Özet
Jinekolojik cerrahi öncesi sistematik preoperatif değerlendirme, perioperatif problemleri önlemek ve postoperatif hasta refahını sağlamak açısından kritik öneme sahiptir. Başarılı bir süreç için anamnez, detaylı fizik muayene, laboratuvar tetkikleri, görüntüleme yöntemleri ve multidisipliner konsültasyonlar bir bütün olarak yönetilmelidir. Anamnez aşamasında hastanın tıbbi geçmişi, kronik hastalıkları, ilaç kullanımı, alerjileri, obstetrik-jinekolojik öyküsü ve anestezi komplikasyonları dahil aile hikayesi sorgulanır. Fizik muayene; göğüs, karın, pelvik bölge ve rektumu kapsayan bütüncül bir yaklaşımla cerrah tarafından gerçekleştirilir. Üreme çağındaki tüm kadınlarda cerrahi öncesi gebelik testi yapılarak gebelik durumu mutlaka dışlanmalıdır. Cerrahi alan enfeksiyonlarını (CAE) önlemek adına, histerektomi gibi üreme sistemine müdahale edilen operasyonlardan önce zamanında profilaktik antibiyotik (genellikle sefazolin) uygulanması ve klorheksidin ile vajinal/cilt hazırlığı yapılması önerilir. Ayrıca ameliyat öncesinde hastaların Caprini skoru gibi yöntemlerle venöz tromboembolizm (VTE) riskleri belirlenmeli ve uygun tromboprofilaksi planlanmalıdır. Obezite, ileri yaş veya kronik sistemik hastalığı olan özel hasta gruplarında ise anestezi uzmanı ve ilgili branşlarla preoperatif konsültasyonlar yapılarak cerrahi teknik, konumlandırma ve ilaç yönetimi bireyselleştirilmelidir. Güncel yaklaşımlarda rutin bağırsak hazırlığı ve endokardit profilaksisi artık standart olarak önerilmemektedir.
Systematic preoperative evaluation before gynecologic surgery is of critical importance for preventing perioperative complications and ensuring postoperative patient well-being. For a successful process, anamnesis, detailed physical examination, laboratory tests, imaging methods, and multidisciplinary consultations must be managed as a whole. During the anamnesis stage, the patient's medical history, chronic diseases, medication use, allergies, obstetric-gynecologic history, and family history, including anesthesia complications, are questioned. The physical examination is performed by the surgeon using a holistic approach covering the breast, abdomen, pelvic region, and rectum. In all women of reproductive age, pregnancy must be ruled out by performing a pre-surgery pregnancy test. To prevent surgical site infections (SSI), timely administration of prophylactic antibiotics (usually cefazolin) and vaginal/skin preparation with chlorhexidine are recommended before operations involving the reproductive tract, such as hysterectomy. Furthermore, patients' venous thromboembolism (VTE) risks should be determined prior to surgery using methods like the Caprini score, and appropriate thromboprophylaxis must be planned. For special patient populations with obesity, advanced age, or chronic systemic diseases, surgical technique, positioning, and medication management should be individualized through preoperative consultations with anesthesiologists and relevant specialties, while routine bowel preparation and endocarditis prophylaxis are no longer standardly recommended.
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