••• CHAPTER 34^ Preoperative Evaluation and Preparation of Gynecologic Surgery^341
❍ How common is pulmonary embolism (PE) following DVT?
PE occurs in 6% to 10% of cases following DVT in an upper extremity and 15% to 32% in a lower extremity.
❍ What is the timing and dosage of heparin for DVT prophylaxis?
5000 units subcutaneously given 2 hours prior to surgery and continued every 8 to 12 hours postoperatively.
❍ Does prophylactic low-dose heparin affect the APTT or increase bleeding complications?
Up to 10% to 15% of normal patients develop a prolonged APTT after 5000 u is given subcutaneously. Also,
increase in bleeding complications and hematoma formation may occur.
❍ How do pneumatic compression stockings compare with heparin in the prevention of DVT?
They are similar to heparin. The stockings must be placed intraoperatively, and particularly in patients with
malignancy, should be maintained for 5 days.
❍ What food allergy may suggest an iodine allergy?
Allergy to shellfish.
❍ How often do allergic reactions to radiologic contrast media occur during intravenous (IV) pyelogram?
Overall, 5% to 8%, with life-threatening reactions occurring in 0.1%.
❍ If allergy to iodine is suspected, and yet an IV pyelogram is necessary, what can be done?
Corticosteroid preparation help to prevent life-threatening anaphylaxis.
❍ Which patients scheduled for hysterectomy are at risk for abnormal IV pyelograms?
Patients with PID, endometriosis, pelvic relaxation, lateral projections of uterine myomas, fixed adnexal masses,
and prior abdominal surgery.
❍ What effect does preoperative nutritional preparation have?
Optimizing nutritional, fluid, and electrolyte status leads to more rapid recovery, better wound healing, and less
postoperative infection.
❍ What components are necessary to calculate the caloric needs of a surgical patient?
Height, weight, sex, age, activity level, type of surgery, and extent of disease.
❍ In consideration of nutritional status, what variables are related to increased surgical morbidity and
mortality?
Generally, hypoalbuminemia (<2.5 mg/dL), and unintended weight loss (>10%).
❍ What are advantages and disadvantages of enteral nutritional supplementation?
Advantages: easy and inexpensive. Disadvantages: high osmolarity can lead to vomiting or diarrhea, or electrolyte
disturbances, and cannot be used with bowel obstruction.