Lecture 4: Operative Process Flashcards
What is the general rule for NPO guidelines prior to surgery?
Nothing to eat or drink after midnight prior to surgery (except sips of water/meds)
In general how long before surgery should NG tubes be stopped?
8 hours prior to surgery
What is the one exception for stopping feeding tubes 8 hours prior to surgery?
If the feeding tube is post-pyloric
What is the timeframe that a SSI must occur within?
Within 30 days or 90 days if a prosthetic was implanted
What are the 4 criteria that define an SSI? (only 1 is needed to make a Dx)
- Purulent exudate
- culture
- Reopened wound d/t signs of infection
- Surgeon’s diagnosis
What are the 2 major differences between SSIs and colonization?
SSI - bacteria elicit a host response, impedes wound healing
Colonization - bacteria DONT elicit a host response, usually doesnt impede would healing in healthy pts
What are the 2 MC organisms that cause SSIs?
- Staph aureus
2. Staph epidermis
What is the difference between clean-contaminated (CC) and contaminated wounds?
CC - body tracts are entered under controlled conditions
Contaminated - body tracts are entered under UNcontrolled conditions (breaks in sterile technique & inflammation present)
What are 1st generation cephalosporins (Cefazolin/Ancef) used for in ABX prophylaxis?
Clean-contaminated wounds
What type of ABX do you use if you need added Gram (-) anaerobic coverage?
- in what types of procedures are these needed?
2nd & 3rd generation cephalosporins alone
Needed in Abdominal procedures
In general is routine prophylaxis with Vancomycin recommended?
NO
- unless severe type 1 allergy to PCN
What are the 3 situations that prophylaxis with Vancomycin is appropriate?
- Hospitals where MRSA is freq cause of SSIs
- Pts w/known MRSA colonization
- Pts at high risk for MRSA (nursing home, recent hospitalization)
When should ABX prophylaxis be administered?
What is the exception?
Within 60 minutes of the surgical incision
Give Fluroquinolones & Vancomycin 120 minutes before (longer infusion time)
What is the duration for ABX prophylaxis?
Single dose OR no longer than 24 hours
If a patient has an indwelling catheter or drain is ABX prophylaxis necessary?
NO
When should you consider performing pre-op staph aureus screening?
Cardiac or Ortho procedures, Immunocompromised
high risk for complications if S. aureus infection develops
What is the Universal Protocol designed to prevent and what are its 3 elements?
Prevent wrong person, time, procedure
Elements
- Pre-procedure verification process
- Mark procedure site
- Time Out
What are the guidelines for surgical markings?
Made by surgeon
Mark must be:
- unambiguous (surgeon’s initials)
- near site w/surgical marker that wont be washed off after surgery prep
- must designate L/R, multiples levels or structures
“X” cannot be used!
How do you evaluate airway assessment in a preoperative patient?
"LEMON" L - Look (general impression) E - Evaluate (using 3-3-2 rule) M- Mallampati Score (good is <3) O - Obstruction/obesity N - Neck Mobility
What are the factors associated with a difficult airway for mask ventilation?
BMI >30, beard, edentulous, age >55, Mallampati >3, poor mandibular protrusion, male, airway mass
What are the factors associated with a difficult airway for laryngoscopy/ intubation?
Prior difficult intubation, Mallampati >3, intubate w/out NMBA, male, large neck, cant extend neck
What are the components of a surgical time out prior to incision?
- Team members introduce themselves by name/role
- Surgeon, anesthetist, nurse confirm right pt, site, procedure
- Surgeon, anesthetist, nurse address anticipated events
- Confirmation of ABX prophylaxis w/in last 60 min
- Essential imaging displayed
What are the 3 main types of anesthesia?
- General
- Regional
- MAC (Monitored Anesthesia Care)
What types of procedures use general anesthesia and what are the main IV agents used?
Abdominal, Head, & Neck procedures
Propofol, Ketamine, Etomidate
