====== 🗂️ Perioperative Planning ======

===== 📌 Definition =====
**Perioperative [[planning]]** is the systematic process of preparing, optimizing, and managing a patient before, during, and after surgery to minimize risks, enhance outcomes, and ensure patient safety.

It involves **multidisciplinary coordination**, individualized risk assessment, and structured protocols that span the **preoperative, intraoperative, and postoperative** phases.

===== 🔄 Phases of Perioperative Planning =====

==== 1. 🕑 Preoperative Phase ====
  * **Clinical assessment**:
    - Medical history, physical exam, medication review
    - Anesthesia evaluation
    - Risk scores (ASA, frailty index, cardiac risk)
  * **Laboratory and imaging**:
    - CBC, coagulation panel, renal function
    - ECG, chest X-ray if indicated
    - Neuroimaging (MRI, CT) in neurosurgical cases
  * **Optimization**:
    - Control of comorbidities (e.g., hypertension, diabetes)
    - Correction of coagulopathies or anemia
    - Smoking/alcohol cessation
  * **Medication management**:
    - Hold anticoagulants/antiplatelets if needed
    - Evaluate NSAID use (bleeding risk vs. analgesic benefit)
  * **Informed consent**:
    - Explanation of risks, benefits, and alternatives
    - Documentation of patient understanding and agreement

==== 2. 🧠 Intraoperative Phase ====
  * **Anesthetic plan**:
    - General, regional, or local anesthesia
    - Airway and pain control strategies
  * **Surgical safety protocols**:
    - WHO Surgical Safety Checklist
    - Sterile field, instrument count
  * **Hemostasis and fluid management**:
    - Blood pressure control
    - Coagulation monitoring
    - Use of antifibrinolytics or hemostatic agents
  * **Positioning and neuromonitoring** (in neurosurgery):
    - Prevent nerve injury
    - Use of MEPs/SEPs if applicable

==== 3. 🛌 Postoperative Phase ====
  * **Pain management**:
    - Multimodal analgesia (e.g., acetaminophen, NSAIDs, opioids)
    - Monitor for bleeding if NSAIDs used
  * **Monitoring and early detection**:
    - Vitals, neurological status, wound checks
    - Post-op imaging (e.g., CT brain if craniotomy)
  * **Mobilization and nutrition**:
    - DVT prophylaxis
    - Early ambulation
    - Return to oral intake
  * **Discharge planning**:
    - Wound care instructions
    - Medication reconciliation
    - Follow-up appointments and red-flag education

===== 🧠 Importance in Neurosurgery =====
  * Reduces morbidity from complications (e.g., hemorrhage, infection, seizures)
  * Allows early recognition of neurological decline
  * Supports precise coordination between neurosurgeons, anesthesiologists, intensivists, and rehabilitation teams

===== 🧾 Summary =====
**Perioperative planning** is a cornerstone of modern surgical practice. It ensures that every phase—from preoperative optimization to postoperative recovery—is **customized to the patient’s risk profile**, enhancing safety, efficiency, and outcomes, especially in complex fields like **neurosurgery**.