Hysterectomy

baseline Review the pathway, the fasting clock, pain plan, and who to call.

baseline Start prehabilitation when there are at least 2–4 weeks before surgery: walking, breathing, and protein.

safe_glp1_high_carb Higher-risk GLP-1: carbohydrate drink is held. Factors: escalation phase, high dose, weekly dosing.

safe_red_flag_carb Red flag: BMI over the threshold, steep Trendelenburg, and GLP-1 or gastroparesis or GERD. Carbohydrate drink is held. BMI 46 with steep Trendelenburg plus GLP-1, gastroparesis, or GERD.

note_aspiration Aspiration precautions are on. The carbohydrate and fasting lines above are the plan to print.

safe_glp1_high_fast Higher-risk GLP-1: liquid diet for 24 hours before surgery. Clear water only until the stop-drinks time. Factors: escalation phase, high dose, weekly dosing.

safe_red_flag_fast Red flag fasting: solids at least 8 hours and a 24-hour liquid diet. Consider gastric ultrasound and rapid-sequence induction. ANESTHESIA CONSULT REQUIRED before scheduling. BMI 46 with steep Trendelenburg plus GLP-1, gastroparesis, or GERD.

note_aspiration Aspiration precautions are on. The carbohydrate and fasting lines above are the plan to print.

safe_glp1_high_fast Higher-risk GLP-1: liquid diet for 24 hours before surgery. Clear water only until the stop-drinks time. Factors: escalation phase, high dose, weekly dosing.

safe_red_flag_fast Red flag fasting: solids at least 8 hours and a 24-hour liquid diet. Consider gastric ultrasound and rapid-sequence induction. ANESTHESIA CONSULT REQUIRED before scheduling. BMI 46 with steep Trendelenburg plus GLP-1, gastroparesis, or GERD.

baseline Do not give a long-acting sedative or benzodiazepine premedication.

path_glp1_high Higher-risk GLP-1: 24-hour liquid diet, no carbohydrate drink, consider gastric ultrasound, and anesthesia decides rapid-sequence induction versus delay. Factors: escalation phase, high dose, weekly dosing.

note_escalation Escalation phase: the 2024 guidance supports deferring elective surgery until the dose is stable and GI symptoms have settled.

path_no_prep No mechanical bowel prep for this operation (right colectomy, gynecology, or cystectomy).

path_mis Minimally invasive approach is in the plan. That matches the ERAS preference.

baseline Scheduled acetaminophen unless the liver plan says otherwise.

baseline Give a scheduled NSAID or COX-2 unless a safety rule holds it. Do not tell every patient to stop NSAIDs for 7 days.

baseline Single-dose dexamethasone for analgesia and nausea, unless a rule modifies it.

baseline Use the procedure-specific block.

TAP block or wound infiltration

safe_ponv Apfel score is at the escalation threshold. Use 3–4 antiemetics and total intravenous anesthesia. Apfel 3 (Female, Non-smoker, Postoperative opioids expected).

Apfel 3 (Female, Non-smoker, Postoperative opioids expected). Give 3–4 agents and use total intravenous anesthesia. A typical set is dexamethasone, ondansetron, aprepitant, and a scopolamine patch.

safe_trend_fluids Steep Trendelenburg or robotic pelvic surgery: do not give liberal fluid. Stay goal-directed and on the dry side of euvolemia.

baseline Active warming. Keep core temperature at or above 36°C.

baseline Treat hyperglycemia. Non-diabetic patients need a check only when clinically indicated.

baseline Mechanical prophylaxis plus pharmacologic prophylaxis once hemostasis allows.

baseline Start oral intake as soon as the patient is awake, unless a surgical rule restricts it.

baseline Mobilize the day of surgery or on postoperative day 1.

baseline Remove the urinary catheter on postoperative day 1 unless the operation requires it to stay.

baseline Do not place a drain by routine.

baseline Do not leave a nasogastric tube in by routine.