🗂️ Perioperative Planning

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.

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

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

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

• 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

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.