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2: Surgical Methods and Perioperative Care > Chapters 13, 15, 16, 17 FROM NOTES ONLY > Flashcards

Chapters 13, 15, 16, 17 FROM NOTES ONLY Flashcards

1
Q

What is recommended size of OR

And if fluoro etc?

A

37m2 (400 ft2)

56m2 (600 ft2)

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2
Q

What are recommended OR settings for

Ventilation

Humidity

Temp

A
  • Ventilation: 15 air exhanges/hour, horizontal laminar flow
  • Humidity: 30 - 60%
  • Temp: 20 - 23 Cº

N.B. Laminar airflow –> 61% reduced room bacteria and 92% decreased wound site bacteria

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3
Q

What is antiseptic/disinfectant MoA of:

Alcohols

Povodine-iodine

Chlorhex

A
  • Alcohols: Protein denaturation, lysis, metabolic interruption
  • Povodine-iodine: Free iodine oxidation/substitution –> protein denaturation
  • Chlorhex: Cell membrane disruption
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4
Q

What is gene that confers chlorhex resistance to Staph aureus

A

qacA/B

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5
Q

What % solution chlorhex is used for skin prep?

And in wound

A

4% for skin

0.05% in wound

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6
Q

What 3 factors are associated with increased glove perf

A
  • Non dominant hand
  • Non-ST procedure
  • Sx > 60 mins
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7
Q

What is rate of perf when single gloved/

A

Single gloved:

  • 13 - 31%

Double gloved:

  • 11 - 44% outer glove
  • 4 - 13% inner glove
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8
Q

How does waveform (current) of cutting vs coagulating electrocautery differ

A

Cutting waveform continuous, 100% of time

Coag waveform is intermittent, only 6% of time

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9
Q

For what % of time is cutting coag waveform (i.e. current) ‘active’?

And for coag

A

100% for cutting

6% for coag

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10
Q

What effect does electrosurgery have on tissues at following temperatures?

40ºC

50ºC

70ºC

90ºC

100ºC

250ºC

A

40ºC –> inflammation + oedema

50ºC –> enzyme deactivated

70ºC –> protein denaturation

90ºC –> dessication

100ºC –> vapourization + cell rupture

250ºC –> carbonization

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11
Q

Name three contact types for coagulative electrocautery

A
  • Fulguration coagulation: (not in contact –> arcs –> superfiial coagulum)
  • Dessication coagulation: Direct contact of electrode w tissues. Deeper necrosis + thermal spread than fulguration coagulation.
    • Coaptive coagulation: Instrument grasping vessel –> collagen weld
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12
Q

On what size vessel can monopolar cautery be used?

And enseal/ligasure?

Harmonic scalpel?

Co2 laser?

A

Monopolar ≤2mm

Enseal/Ligasure ≤7mm

Harmonic scalpel <3mm

CO2 laser <0.6mm

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13
Q

What is conculsion re using monopolar cautery for skin?

(Scott, VetSurg, 2017)

(Meakin, VetSurg, 2017)

A

Scott, VetSurg, 2017

  • Better haemostasis
  • Faster

BUT

  • Increased complications
  • Delayed healing

Don’t do it.

Meakin, VetSurg, 2017

  • Less blood loss
  • Same duration
  • Same complications/healing
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14
Q

List 2 advantages and 2 disadvantages of bipolar (vs monopolar)

A
  • Less collateral damage
  • Can be used when wet

BUT

  • Cant cut
  • Can adhere to surrounding tissue
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15
Q

List the three machanisms of injury from stray energy

A
  • Insulation failure
  • Direct coupling (metal - metal)
  • Capacitive coupling (e.gg. current builds up in isolator (e.g. air)
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16
Q

What is thermal spread of ligasure?

And enseal?

harmonic scalpel?

A

1 - 3 mm Ligasure

2 mm EnSeal (only system to limit thermal spread)

0 - 1 mm Harmonic

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17
Q

At what vibration does harmonic scalpel funtion

A

55,000 vibrations/s

Cuts + coagulates simultaneously (vibration induced heat –> coaptive coagulation)

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18
Q

List 5 benefits of harmonic scalpel over BSVD

A
  • Reduced smoke/vapour
  • Cuts + coags at same time
  • Lower temp (50-100 vs 150 - 400)
  • Less thermal spread
  • No char/dessication/sticking
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19
Q

Which device –> highest bursting pressure

And fastest sealing time

A

Enseal

Harmonic

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20
Q

What does LASER stand for

A

Light amplification by stimulated emission of radiation

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21
Q

List 4 characteristics of LASER photons

A
  • Monochromic (same waveform)
  • Spacial coherence (move parallel)
  • Temporal coherence (in phase)
  • Collimated (linear direction)
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22
Q

How does tissue penetration differ between long and short wavelength lasers

Give an example or a long wavelenght laser

And short

A

Long wavelength have lower tissue penetration

Long wavelenght: CO2, Ho:YAG, Erbium:YAG

Short wavelength: Nd:YAG (deepest tissue penetration!), diode

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23
Q

Relasers, what does YAg stand for

A

Yttrium - Aluminum - Garnet

24
Q

What are the zones of injury from laser

A
  • Zone of carbonization
  • Zone of vapourization
  • Zone of coagulation (all necrotic)
  • Zone of hyperthermia

N.B. Burn wound zones are

  • Zone of coagulation (necrotic)
  • Zone of stasis (viable, can repair with support or may necrose)
  • Zone of hyperaemia (viable)
25
List three modes of LASER tissue injury
* Photothermal * Photochemical * Photomechanical
26
What is wavelenght of CO2 laser and Ho:YAG
CO2 10,600 nm Ho:YAG 2100 nm
27
How does CO2 laser cut tissue
Intracellular water heated --\> vaporization --\> cell lysis
28
Name a specific feature of Er:YAG laser
Absorbed by hydroxyapatite so good for cutting bone
29
Which laser has deepest tissue penetration? What is its wavelenght
Nd:YAG 1064 nm wavelenght
30
List 3 safety concerns re lasers
* Ocular damage * Toxic smoke production * Fire hazerd * Mutagenesis * Adverse effect on neighbouring tissues due to energy disipation
31
What are Halsted's principles (7!)
1. Gentle tissue handling 2. Meticulous haemostasis 3. Preservation of blood supply 4. Accurate tissue apposition 5. Obliteration of dead space 6. Minimal tension 7. Strict aseptic technique
32
$ scalpel motions
Slicing Pressing Sawing Scraping
33
The forces by scissors
* Closing * Shearing * Torque
34
What instruent use accounts for most instrument related wasted surgical time
Inefficient needle holder use
35
List 4 needle holder grips
* Thumb-ringfinger * Thenar (quick for simple continuous) * Palmed (most powerful) * Pencil (for v delicate)
36
What 3 sutures can be used in Si
simple interrupted simple cont modified gambee
37
What suture pattern is this?
Modified gambee N.B. compare to vertical mattress
38
What continuous suture patterns are inverting. How do they differ from one another
Cushing, connell, lembert * Cushing and Connell take *bites parallel* with wound. * Cushing and Lembert *partial thickness*
39
What suture pattern is this
Lembert N.B. Compare with vertical mattress
40
What is relative knot security of monofilament absorbable (relative knot security = knot holding capacity in % of tensile strength of suture)
67% i.e. knot = weakest part
41
What is the definition of knot pullout strength? And just "knot strenght"
_Knot pullout strength:_ Load required to break suture deformed by a knot (deformation from knot usually --\> 10 - 40% loss of strenght) _Knot strength:_ Force necessary to cause knot to slip
42
What is suture pull out value (wight required to pull suture loop from tissue) of following tissues * Fat * Muscle * Skin * Fascia
* Fat 0.2 kg * Muscle 1.2 kg * Skin 1.8 kg * Fascia 3.8 kg
43
What are the netric sized of 4/0 3/0 2/0 0 1
4/0 --\> 1.5 3/0 --\> 2 2/0 --\> 3 0 --\> 3.5 1 --\> 4
44
What are the two mechanisms of suture absorbtion?
Hydrolysis and enzymatic | (Synthetic ones absorbed by hydrolysis)
45
Which suture types lose strngth more rapidly in alkaline vs acidic environment? Which suture type is resistant to degradation regardless of pH
Alkaline: Sutures with glycolide componend i.e. polyglecaperone 25 (Monocryl) and polyglyconate (Maxon) Acidic: Those with dioxanone component i.e pds Polypropylene resistant
46
At what time do following sutures reach 50% strength? And how long to be absorbed? * Vicryl * Monocryl * PDS
* Vicryl: 50% strength at 2-3 weeks, absorbed 56 - 70d * Monocryl: 50% strenght at 1-2 weeks, absorbed by 119d * PDS: 50% strength at 5-6 weeks, absorbed by 180 N.B catgut (chromic or not, has 0% strength at 2 weeks and had unpredicatble absorbtion rate)
47
Where does silk come from
*Bombyx mori* silk worm
48
What is absorbability of silk
Considered 'non-absorbable' but lost 56% strength after 12 weeks and gone after 2 years (by hydrolysis) High tissue reactivity
49
What suture has highest break point
Polypropylene
50
List unique feature of polypropylene
V resistant to breakdown as doesnt have any hydrolysable bonds V strong
51
What is the purpose of the low carbon in 316 L SS
Less carbon --\> less corrosion
52
What is difference between woven and knitted mesh?
Woven is stronger and stiffer, but less porous i.e. knitted more flexible and porous (porous desireable for collagen in-growth
53
What is recommended mesh overlap amount in areas of high tension? And if not high tension
Overlap mesh 1 cm with native tissue if high tension Otherwise overlap 0.6cm
54
List 4 principles of vacular clip application
* Skeletonize vessel * Clip artery and vein separately * Vessel size 33-66% of clip size * Apply clip several mm from cut edge
55
What size do the following staples close to? 4. 8mm (green) 3. 5mm (blue) 2. 5mm (white)
* 4.8mm (green) --\> 2.0mm * 3.5mm (blue) --\> 1.5mm * 2.5mm (white) --\> 1.0mm

2: Surgical Methods and Perioperative Care (11 decks)

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