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Preparing for Urgent or Emergent Surgery

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Handbook of Consult and Inpatient Gynecology

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Abstract

This chapter reviews a variety of core issues to consider while preparing for emergent gynecologic surgery, including assessment of surgical risk, preoperative testing, informed consent, prophylaxis against infection and thromboembolism, urgent anticoagulation reversal, and resuscitation of hemorrhagic shock.

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References

  1. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:e278–333.

    Article  PubMed  Google Scholar 

  2. American College of Surgeons. ACS NSQIP surgical risk calculator. http://riskcalculator.facs.org/ Accessed 10 Aug 2015.

  3. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 2002 guidelines on perioperative cardiovascular evaluation for noncardiac surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007;50:1707–32.

    Article  PubMed  Google Scholar 

  4. Khavanin N, Lovecchio FC, Hanwright PJ, Brill E, Milad M, Bilimoria KY, et al. The influence of BMI on perioperative morbidity following abdominal hysterectomy. Am J Obstet Gynecol. 2013;208:449.e1–6.

    Article  Google Scholar 

  5. Committee on Gynecologic Practice. Committee opinion no. 619: gynecologic surgery in the obese woman. Obstet Gynecol. 2015;125:274–8.

    Article  Google Scholar 

  6. Feely MA, Collins CS, Daniels PR, Kebede EB, Jatoi A, Mauck KF. Preoperative testing before noncardiac surgery: guidelines and recommendations. Am Fam Physician. 2013;87:414–8.

    PubMed  Google Scholar 

  7. Ransom SB, McNeeley SG, Hosseini RB. Cost-effectiveness of routine blood type and screen testing before elective laparoscopy. Obstet Gynecol. 1995;86:346–8.

    Article  CAS  PubMed  Google Scholar 

  8. Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012;116:522–38.

    Google Scholar 

  9. van Klei WA, Bryson GL, Yang H, Kalkman CJ, Wells GA, Beattie WS. The value of routine preoperative electrocardiography in predicting myocardial infarction after noncardiac surgery. Ann Surg. 2007;246:165–70.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Poirier P, Alpert MA, Fleisher LA, Thompson PD, Sugerman HJ, Burke LE, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation. 2009;120:86–95.

    Article  PubMed  Google Scholar 

  11. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27:97–132.

    Article  CAS  PubMed  Google Scholar 

  12. American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedure. Obstet Gynecol. 2009;113:1180–9.

    Article  Google Scholar 

  13. Larsson PG, Carlsson B. Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Infect Dis Obstet Gynecol. 2002;10:133–40.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW, American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133:381S–453.

    Article  CAS  PubMed  Google Scholar 

  15. American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 84: prevention of deep vein thrombosis and pulmonary embolism. Obstet Gynecol. 2007;110:429–40.

    Google Scholar 

  16. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e326S–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA Jr, et al. Prevention of venous thromboembolism. Chest. 2001;119:132S–175S.

    Google Scholar 

  18. Corr BR, Winter AM, Sammel MD, Chu CS, Gage BF, Hagemann AR. Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery. Gynecol Oncol. 2015;38:501–6.

    Article  Google Scholar 

  19. Kaur M, Sinha C, Singh P, Gupta B. Identification of occult deep vein thrombosis before the placement of sequential compression devices. In J Anaesth. 2012;56:593–5.

    Google Scholar 

  20. Francis CW, Crowther M. Chapter 23. Principles of antithrombotic therapy. In: Lichtman MA, Kipps TJ, Seligsohn U, Kaushansky K, Prchal JT, editors. Williams hematology. 8th ed. New York: McGraw-Hill; 2010. http://accessmedicine.mhmedical.com.ezp-prod1.hul.harvard.edu/content.aspx?bookid=358&Sectionid=39835840. Accessed 24 July 2015.

  21. Crowther M, Crowther MA. Antidotes for novel oral anticoagulants: current status and future potential. Arterioscler Thromb Vasc Biol. 2015;35:1736–45.

    Article  CAS  PubMed  Google Scholar 

  22. Pollack Jr CV, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373:511–20.

    Article  CAS  PubMed  Google Scholar 

  23. Miller MP, Trujillo TC, Nordenholz KE. Practical considerations in emergency management of bleeding in the setting of target-specific oral anticoagulants. Am J Emerg Med. 2014;32:375–82.

    Article  PubMed  Google Scholar 

  24. Garcia DA, Baglin TP, Weitz JI, Samama MM. American College of Chest Physicians. Parenteral anticoagulants: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e24S–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Committee on Trauma. Advanced trauma life support 1 student manual. 8th ed. Chicago: American College of Surgeons; 2008.

    Google Scholar 

  26. Riskin DJ, Tsai TC, Riskin L, Hernandez-Boussard T, Purtill M, Maggio PM, et al. Massive transfusion protocols: the role of aggressive resuscitation versus product ratio in mortality reduction. J Am Coll Surg. 2009;209:198–205.

    Article  PubMed  Google Scholar 

  27. Holcomb JB, Wade CE, Michalek JE, Chisholm GB, Zarzabal LA, Schreiber MA, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008;248:447–58.

    PubMed  Google Scholar 

  28. Holcomb JB, Zarzabal LA, Michalek JE, Kozar RA, Spinella PC, Perkins JG, et al. Increased platelet: RBC ratios are associated with improved survival after massive transfusion. J Trauma. 2011;71:S318–28.

    Article  PubMed  Google Scholar 

  29. Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011;83:719–24.

    PubMed  Google Scholar 

  30. Holland LL, Foster TM, Marlar RA, Brooks JP. Fresh frozen plasma is ineffective for correcting minimally elevated international normalized ratios. Transfusion. 2005;45:1234–5.

    Article  PubMed  Google Scholar 

  31. Erber WN, Perry DJ. Plasma and plasma products in the treatment of massive haemorrhage. Best Pract Res Clin Haematol. 2006;19:97–112.

    Article  CAS  PubMed  Google Scholar 

  32. Levy JH, Szlam F, Tanaka KA, Sniecienski RM. Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding. Anesth Analg. 2012;114:261–74.

    Article  CAS  PubMed  Google Scholar 

  33. Fischerova D. Urgent care in gynaecology: resuscitation and management of sepsis and acute blood loss. Best Pract Res Clin Obstet Gynaecol. 2009;23:679–90.

    Article  PubMed  Google Scholar 

  34. Li J, Sun SL, Tian JH, Yang K, Liu R, Li J. Cell salvage in emergency trauma surgery. Cochrane Database Syst Rev. 2015;(1):CD007379.

    Google Scholar 

  35. Takeda A, Manabe S, Mitsui T, Nakamura H. Management of patients with ectopic pregnancy with massive hemoperitoneum by laparoscopic surgery with intraoperative autologous blood transfusion. J Minim Invasive Gynecol. 2006;13:43–8.

    Article  PubMed  Google Scholar 

  36. Yamada T, Okamoto Y, Kasamatsu H, Mori H. Intraoperative autologous blood transfusion for hemoperitoneum resulting from ectopic pregnancy or ovarian bleeding during laparoscopic surgery. JSLS. 2003;7:97–100.

    PubMed  PubMed Central  Google Scholar 

  37. James AH, Kouides PA, Abdul-Kadir R, Dietrich JE, Edlund M, Federici AB. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol. 2011;158:124–34.

    Google Scholar 

  38. CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23–32.

    Google Scholar 

  39. Henry DA, Carless PA, Moxey AJ, O’Connell D, Stokes BJ, Fergusson DA et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2011;(3):CD001886.

    Google Scholar 

  40. Siegal DM, Garcia DA, Crowther MA. How I treat target-specific oral anticoagulant-associated bleeding. Blood. 2014;123:1152–8.

    Google Scholar 

  41. Sundström A, Seaman H, Kieler H, Alfredsson L. The risk of venous thromboembolism associated with the use of tranexamic acid and other drugs used to treat menorrhagia: a case–control study using the General Practice Research Database. BJOG. 2009;116:91–7.

    Article  PubMed  Google Scholar 

  42. Santoso JT, Saunders BA, Grosshart K. Massive blood loss and transfusion in obstetrics and gynecology. Obstet Gynecol Surv. 2005;60:827–37.

    Article  PubMed  Google Scholar 

  43. Arya RC, Wander G, Gupta P. Blood component therapy: which, when and how much. J Anaesthesiol Clin Pharmacol. 2011;27:278–84.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bell SF, Rayment R, Collins PW, Collis RE. The use of fibrinogen concentrate to correct hypofibrinogenemia rapidly during obstetric haemorrhage. Int J Obstet Anesth. 2010;19:218–23.

    Article  CAS  PubMed  Google Scholar 

  45. Pereira J, Phan T. Management of bleeding in patients with advanced cancer. Oncologist. 2004;9:561–70.

    Google Scholar 

  46. Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med. 2007;356:2301–11.

    Google Scholar 

  47. Sørensen B, Spahn DR, Innerhofer P, Spannagl M, Rossaint R. Clinical review: Prothrombin complex concentrates–evaluation of safety and thrombogenicity. Crit Care. 2011;15:201.

    Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, USA

    Paula C. Brady MD & Julianna Schantz-Dunn MD, MPH

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  1. Paula C. Brady MD
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  2. Julianna Schantz-Dunn MD, MPH
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Correspondence to Paula C. Brady MD .

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© 2016 Springer International Publishing Switzerland

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Brady, P.C., Schantz-Dunn, J. (2016). Preparing for Urgent or Emergent Surgery. In: Handbook of Consult and Inpatient Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-27724-0_13

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  • DOI: https://doi.org/10.1007/978-3-319-27724-0_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27722-6

  • Online ISBN: 978-3-319-27724-0

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