SU10.1 | Principles of Perioperative Management — Summary & Reflection

KEY TAKEAWAYS

Perioperative management is the coordinated care of a surgical patient across three phases — preoperative, intraoperative and postoperative — and it is where most preventable surgical harm is avoided. The governing principles are: risk-stratify with ASA physical status (which grades the patient's systemic disease, with an E suffix for emergencies — not the operation, and not the Mallampati airway grade); optimise correctable conditions; fast by the 2-4-6-8 rule; and give prophylaxis — VTE (mechanical plus LMWH) and surgical antibiotics within 60 minutes before incision. The keystone intraoperative safety system is the WHO Surgical Safety Checklist with three pause-points: Sign In before induction, Time Out before incision, Sign Out before leaving theatre. Postoperatively, deliver analgesia, fluids, early feeding and mobilisation and active complication surveillance, with ERAS spanning all phases. Interpret the deteriorating patient from the trend in observations and the postoperative day — remembering that hypotension is a late sign of bleeding and the 'five Ws' frame postoperative fever — and escalate early.

REFLECT

Think back to the last surgical patient you saw, in clinic, on the ward or in theatre. Could you now place every piece of their care into the preoperative, intraoperative or postoperative phase, and name the principle behind it — why the fasting time was set as it was, why a particular prophylaxis was prescribed, why the team paused before incision? When you next join a ward round, watch the observation chart of a postoperative patient: what is the trend telling you, and on which postoperative day are they? Reflect on one habit you will deliberately build now — confirming consent and site yourself before theatre, or always reading the trend rather than a single observation — so that safe perioperative thinking becomes automatic before you carry the responsibility for it.