010 Principles of Urologic Surgery - Intraoperative Technical Decisions

Question 1

The two primary reasons for hypothermia in the operating room are __ that occurs with anesthetic agents and __ as the body interacts with the environment.

Answer 1

The two primary reasons for hypothermia in the operating room are PERIPHERAL VASODILATION that occurs with anesthetic agents and RADIATION OF HEAT as the body interacts with the environment.

Question 2

Normothermia is defined as a core temperature between __, and either hypothermia or hyperthermia may have adverse perioperative outcomes, including __ and __.

Answer 2

Normothermia is defined as a core temperature between 36C and 38C, and either hypothermia or hyperthermia may have adverse perioperative outcomes, including INCREASED BLOOD LOSS and INCREASED INCIDENCE OF SURGICAL SITE INFECTION.

Question 3

Strategies to maintain normothermia include __, __, __, and __.

Answer 3

Strategies to maintain normothermia include PATIENT WARMING BLANKETS, WARMED INTRAVENOUS AND IRRIGATION FLUIDS, WARMED CO2 INSUFFLATION DURING LAPAROSCOPY, and AN INCREASE IN AMBIENT OPERATING ROOM TEMPERATURE.

Question 4

Commonly used skin antiseptic solutions for sterile skin preparation include __, __, and __, none of which has proven to be superior to the others in reducing SSI.

Answer 4

Commonly used skin antiseptic solutions for sterile skin preparation include ALCOHOL, POVIDONE-IODINE, and CHLORHEXIDINE-BASED SOLUTIONS, none of which has proven to be superior to the others in reducing SSI.

Question 5

If hair is to be removed, it should preferably be removed immediately before the surgical procedure with __.

Answer 5

If hair is to be removed, it should preferably be removed immediately before the surgical procedure with CLIPPERS.

Question 6

Three commonly occuring and preventable injuries in the operating room are __, __, and __.

Answer 6

Three commonly occuring and preventable injuries in the operating room are RETRACTOR-ASSOCIATED INJURIES, THERMAL INJURIES, and PATIENT POSITION-RELATED INJURIES.

Question 7

Peripheral neuropathy may result from improper patient positioning and is often secondary to __, __, or __.

Answer 7

Peripheral neuropathy may result from improper patient positioning and is often secondary to EXCESSIVE STRETCH, PROLONGED COMPRESSION, or ISCHEMIA OF A NERVE.

Question 8

When positioning in lithotomy, care should be taken to manipulate both lower extremities simultaneously with flexion of the hips at __ degrees with __-degree abduction.

Answer 8

When positioning in lithotomy, care should be taken to manipulate both lower extremities simultaneously with flexion of the hips at 80 to 100 degrees with 30- to 45-degree abduction.

Question 9

Current indications for packed red blood cell transfusion include __, __, or __.

Answer 9

Current indications for packed red blood cell transfusion include HEMATOCRIT LOWER THAN 21%, MAINTENANCE OF HEMATOCRIT OF GREATER THAN 30% IN PATIENTS WITH HIGH RISK OF MYOCARDIAL ISCHEMIA, or IN PATIENTS WITH HEMATOCRIT 21% TO 30% WITH SIGNS OF INADEQUATE OXYGEN-CARRYING CAPACITY.

Question 10

Platelet transfusion may be beneficial in patients with severe thromboyctopenia (<50,000/mm3) who are __, or in patients with moderate thrombocytopenia (50-100,000/mm3) who are __.

Answer 10

Platelet transfusion may be beneficial in patients with severe thromboyctopenia (<50,000/mm3) who are UNDERGOING A PLANNED SURGICAL PROCEDURE, or in patients with moderate thrombocytopenia (50-100,000/mm3) who are UNDERGOING A HIGH-RISK PROCEDURE OR HAVE EVIDENCE OF PLATELET DYSFUNCTION.

Question 11

The indications for fresh frozen plasma are __, __, and __.

Answer 11

The indications for fresh frozen plasma are IMMEDIATE REVERSAL OF WARFARIN, REPLACEMENT OF SPECIFIC CLOTTING FACTORS, and EVIDENCE OF BLEEDING IN THE SETTING OF AN INR GREATER THAN 1.5.

Question 12

Adjunct hemostatic agents may be broadly classified as __ or __.

Answer 12

Adjunct hemostatic agents may be broadly classified as DRY MATRIX AGENTS or BIOLOGICALLY ACTIVE AGENTS.

Question 13

__ (Fibrillar, Surgicel, Nu-Knit) aid in surgical hemostasis by activating the body’s natural clotting cascade.

Answer 13

OXIDIZED REGENERATED CELLULOSE AGENTS (Fibrillar, Surgicel, Nu-Knit) aid in surgical hemostasis by activating the body’s natural clotting cascade.

Question 14

__ (Thrombin-JMI, Evithrom, Recothrom) and the combination of __ with a __ (Floseal and Surgiflo) are not inhibited by urine and additionally resist stone formation within the urinary tract, making them advantageous hemostatic agents for use in urologic surgery.

Answer 14

TOPICAL THROMBIN AGENTS (Thrombin-JMI, Evithrom, Recothrom) and the combination of THROMBIN SEALANTS with a GELATIN MATRIX (Floseal and Surgiflo) are not inhibited by urine and additionally resist stone formation within the urinary tract, making them advantageous hemostatic agents for use in urologic surgery.

Question 15

Numerous studies have shown that __ may not be of benefit in the perioperative period and may cause pain and lead to an increased risk of SSI; therefore the routine use is not recommended outside of specific indications to do so.

Answer 15

Numerous studies have shown that SURGICAL DRAINS may not be of benefit in the perioperative period and may cause pain and lead to an increased risk of SSI; therefore the routine use is not recommended outside of specific indications to do so.

Question 16

The surgical scar regains __ of strength at 1 week, __ at 3 weeks, and __ at 3 months.

Answer 16

The surgical scar regains 3% of strength at 1 week, 20% at 3 weeks, and 80% at 3 months.

Question 17

__ should be avoided when contact with urine is anticipated, such as during urinary tract anastomosis, because this increases the risk of stone development.

Answer 17

NONABSORBABLE SUTURES should be avoided when contact with urine is anticipated, such as during urinary tract anastomosis, because this increases the risk of stone development.

Question 18

The risk of incisional hernia formation IS/IS NOT increased between slowly absorbable and nonabsorbable suture material in continuous versus interrupted fascial closures, although closure with nonabsorbable suture material was associated with increased wound pain.

Answer 18

The risk of incisional hernia formation IS NOT increased between slowly absorbable and nonabsorbable suture material in continuous versus interrupted fascial closures, although closure with nonabsorbable suture material was associated with increased wound pain.

Question 19

__ used for continuous fascia closure are associated with an increased incidence of incisional hernias.

Answer 19

RAPIDLY ABSORBABLE SUTURES used for continuous fascia closure are associated with an increased incidence of incisional hernias.

Question 20

Fascia dehiscence generally occurs __ but may occur up to 30 days after surgery.

Answer 20

Fascia dehiscence generally occurs 7 TO 10 DAYS POSTOPERATIVELY but may occur up to 30 days after surgery.

Question 21

In the presence of infection, __ (Vicryl, Mersilene) should be avoided for wound closure.

Answer 21

In the presence of infection, BRAIDED SUTURES (Vicryl, Mersilene) should be avoided for wound closure.

Question 22

Using __ for skin closure as opposed to sutures has been shown to decrease incision closure time, reduce the risk of wound infection, and has resulted in nonsignificant differences in cosmetic outcomes and patient satisfaction with wound appearance.

Answer 22

Using STAPLES for skin closure as opposed to sutures has been shown to decrease incision closure time, reduce the risk of wound infection, and has resulted in nonsignificant differences in cosmetic outcomes and patient satisfaction with wound appearance.