Enhanced recovery after gynaecological surgery — structured SAQ (15 marks)

(a) Preoperative preparation — 4 marks

• Counsel on functional milestones, analgesia, feeding, mobilisation and discharge criteria.
• Optimise anaemia, diabetes, nutrition, smoking, medicines and VTE risk.
• Follow local fasting policy; consider selected carbohydrate loading only after aspiration-risk review.
• Avoid routine mechanical bowel preparation unless the planned procedure requires it.

(b) Intraoperative plan — 4 marks

• Minimally invasive access if oncologically appropriate; antibiotic and VTE prophylaxis.
• Maintain normothermia and individualised euvolaemia; avoid salt-water overload.
• Multimodal opioid-sparing analgesia with paracetamol, NSAID if safe and local/regional technique.
• Multimodal PONV prophylaxis using different classes plus baseline-risk reduction.

(c) Postoperative orders — 5 marks

• Scheduled non-opioid analgesia; limited opioid rescue and pain-on-movement review.
• Early oral fluids and food as tolerated; stop IV fluid when oral intake and haemodynamics are adequate.
• Sit out and walk with assistance using explicit goals.
• Remove urinary catheter early with a documented trial-of-void plan; review every drain daily.
• Continue indicated VTE prophylaxis; set criteria-led discharge and safety net.

(d) Reasons to deviate — 2 marks

• Haemorrhage, sepsis, respiratory compromise or suspected visceral injury: ABCDE and targeted escalation.
• Persistent vomiting/distension, ileus/obstruction, retention or physiological instability: pause the relevant element and investigate.