Imagine that you have decided that the patient will need surgery as part of their treatment. This decision is rarely made after the first consultation but rather after a trial of medical treatment. Having made the decision to operate, what should you do before operating? See the preoperative checklist below.
It is important to prepare your patient in order to:
• Minimize the amount of surgical manipulation required.
• Preserve as much olfactory mucosa as possible.
• Reduce peroperative bleeding to reduce the likelihood of complications.
• Work out the surgical anatomy in order to minimize the chance of entering the orbit or skull base.
• Set clear goals for yourself and your patient: A disciplined approach to surgery will mean that you will be less likely to embark on an "endoscopic safari", which could result in excessive surgery, increased recovery time for your patient, and the risk of complications.
The Preoperative Checklist
1 Confirm the diagnosis.
2 Review previous medical treatment.
3 Optimize the immediate preoperative condition.
4 Check that relevant investigations have been done:
- Immune status
Fig. 8.1 A patient who has not responded to multiple courses of antibiotics—consider their immunity before operating.
- Hematological parameters
5 Review the relevant medical history, e.g., drug allergies, medication.
6 Preoperative CT checklist.
7 Planning and staging the procedure.
It is good practice to see the patient 10-14 days before surgery in order to maximize the appropriate pre-operative medical treatment and to go over advice and consent. It is not best practice to obtain consent on the day of surgery as the patient may feel pressurized.
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