ABSTRACT
Perioperative care of pediatric and adolescent gynecology patients is reviewed including diet restriction guidelines prior to general anesthesia or sedation and options for preoperative laboratory evaluation. Most procedures in gynecology do not require antibiotic prophylaxis. If indicated, dosing should be weight dependent and not exceed adult dosing. Mechanical bowel prep and oral antibiotics are indicated for patients with planned entry into the gastrointestinal tract, undergoing procedures in close proximity to the anus or rectum, or undergoing vaginal reconstruction. When the patient is a minor, consent must be obtained from a parent or legal guardian, and ideally assent should be obtained from the patient, if developmentally appropriate. There are no general guidelines for adolescents or obese children regarding surgery-related deep vein thrombosis prophylaxis; sequential compression devices should be considered in the operating room and also postoperatively for nonambulatory patients or those on prolonged bedrest. Care should be taken when positioning patients for surgery to prevent iatrogenic injury. Postoperative pain management should be multimodal, including alternating acetaminophen and nonsteroidal anti-inflammatory drugs, the judicious use of opioids including via patient-controlled analgesia, regional analgesia, and pre-incision surgical site local anesthetic infiltration. Enhanced Recovery After Surgery protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures and should be implemented when possible.
