Minor Surgery Flashcards
Sterlization
any process that eliminated or kills all forms of life present on a surface, contained in a fluid, in medication, or in a biological culture media
Disinfection
destroy micro-organisms (but not endospores and viruses) found on non-living objects by destroying the cell wall or interfering with the cell metabolism
Antisepsis
Process of using heat, chemicals, or ultraviolet rays to kill mostly or nearly all microorganisms on skin, in wounds, on mucous membranes, on clothing, and on hard surfaces
What are the types of antispetics?
60-90% alcohols
iodine
2-4% chlorhexidine gluconate (Hibicllens, Hibiscrub, Hibitane)
H2O2
Nonionic surfactants (shur-clens and pharmaClens)
Calendula succus
Minor surgery tincture
Green soap
Sterile saline ampoules
What are the pros/cons of 60-90% alcohols
Pros
* Rapidly kills all fungi, bacteria, including mycobacteria, most viruses, including HBV, HCV and HIV on skin
* Commonly available
* Inexpensive
* Ethyl is less drying
Cons
* Easily inactivated by organic materials, such as dirt, blood, foreign bodies
* Flammable- make sure its try
* Damage latex
* Will repopulate the area quickly
* Will dry mucous membranes
what are the pros/cons of iodine?
Pros
* Inexpensive
* Effective
* Widely available
* Broad spectrum
* Non Irritating to mucous membrane on skin
Cons
* Can cause skin irritation
* Requires at least 2 minutes
* Minimal residual antimicrobial effect
* Rapidly inactivated by organic materials
* Absorption of free iodine through skin and mucous membranes may cause hypothyroidism in newborns
* Can cause allergic reaction
what are the different types of idoine antispetics?
3% iodine
7-10% iodophors
Povidone-idoine
Betadine surgical scrub
Betadine solution
Betadine solution swabsticks
What are the pros/cons of 2-4% chlorhexidine gluconate (Hibicllens, Hibiscrub, Hibitane)?
Pros
* Good alternative to iodophors
* Board antimicrobial spectrum
* Persistent skin action
* Increased inhibition of numbers of microbes with repeated use
* Minimal affected by organic material
Cons
* Action is reduced/neutralized by natural soap, substances present in hard tap water, and some hand creams
* Not effective against tubercle bacillus, only fairly active against fungi
* Decomposes if used above pH of 8
* Avoid contact with eyes as it can cause conjunctivitis
* Allergic reaction
What are the pros/cons of H2O2?
Pros
* cleaning very dirty wounds and those encrusted with blood
* Very good to remove blood and iodine from clothing
Con
* Not use on freshly sutured
* Ulceration
* Toxic to fibroblasts
* Never use to pack sinus tracts
* Never use for forceful irrigation
what are the pros/cons of Nonionic surfactants (shur-clens and pharmaClens)?
P
no tissue toxicity, including the eye and cornea
c
they have no antibacterial activity
what are the pros of calendula succus?
effective wound cleaning and wound healing
What are the pros of NUNM minor surgery tincture?
Cleaning
Dec infection
Encourages wound healing
What characteristics should be considered when choosing an antiseptic?
Can it physically remove dirt and other material as well as some transient microorganisms from the skin?
how long its effects last on skin
is it safe
how expensive
Which is considered the best pre-surgical antiseptic?
Povidone-iodine (Betadine®)
Post-operative infection is determined by what risk factors?
Number of microorganisms entering the wound.
Type and virulence (ability to cause disease) of the bacteria
Strength of the patient’s defense mechanisms (e.g., status of the immune system)
External factors, i.e. surgery over 4 hours in duration, length of hospital stay, etc
What are the pros/cons of shaving skin before surgery
pros
* clears the area for surgery
Cons
* can provide a portal for entry of secondary infections
How to establish a sterile felid?
No shaving the area
Scrubbing the hands and apply the gloves with sterile technique
Wash it with soap and clean water or alcohol
Dry the area before applying the antiseptics
Apply betadine 3 times in circles
Open fenestrated drape
What is sterile hand washing technique?
Clean nails with nail file
Repeatedly cleanse (at least three times – up to 5 minutes) from the hand up to elbow always insuring that the contaminated debris is moved away from the fingers.
When the scrubbing is complete hold the hands a little above the elbows to allow the excess water to drip off at the elbows.
What are the types of sterilization?
heat + pressure
ionizing radiation
UV radiation
chemical
filtration
dry
cold
which is the most effect form of sterlization?
moist heat + pressure (autoclaving)
which is the best sterlization technique for sharp instruments?
chemical ethylene oxide or ozone gas
how are ester metabolized in the body?
Hydrolyzed and inactivated primarily by plasma esterase and excreted via kidney
Which one causes allergic reactions more often ester or amide?
ester
Which is safe in pregnancy ester or amide?
ester
what are the ester anesthetics?
Procaine(Novocaine)
Benzocaine
Chloroprocaine
Cocaine
Cyclomethycaine
Dimethocaine/Larocaine
Propoxycaine
Proparacaine(Opthaine)
Tetracaine/Amethocaine
Cetacaine (Rosta Spray)
what are the amide?
Articaine
Bupivacaine(Marcaine)
Cinchocaine/Dibucaine
Etidocaine
Levobupivacaine
Lidocaine (Xylocaine)/Lignocaine
Mepivacaine(Carbocaine)
Piperocaine
Prilocaine (EMLA cream=with lidocaine;2.5%ea)
Ropivacaine
Trimecaine
Procaine(Novocaine)
use with epinephrine for trigger point therapy
high risk of reaction
Which are the four most common local anesthetic agents used for minor surgery?
lidocaine
bupivacaine
procaine
tetracaine
Tetracaine (Pontocaine)/Amethocaine
Very potent and toxic anesthetic
More potent than procaine
Longer lasting effect
Used for spinal blocks
Tetracaine-adrenaline-cocaine
Good for children
No needle stick
Can’t be used in distal end organs
5-10 min will have effects
Proparacaine(Opthaine)
Topical eye
Subtle foreign body removal or ocular pressure testing
Can cause corneal opacification and loss of vision
contraindicated in patients with known hypersensitivity reactions, numerous allergies, cardiac disease and hyperthyroidism.
Effects last 15-20 min
Refrigerated
Ethyl chloride
Pros
Use with those afraid of needles or with pain with needle
Cons
Inhalation may produce narcotic, deep general anesthetic effects, fatal coma, or cardiac arrest
Don’t use in children
Do not spray in eye
Highly flammable
Uses
Lancing furuncles and carbuncles
How to use
Spray bottle is held approximately 3-12 inches away from the site and sprayed directly on the skin. The anesthetic effect is extremely short lived (15-60 seconds).
Spray just until the skin starts to turn white – stop before the skin frosts
how are amides metabolized?
endoplasmic reticulum in the liver
Which one is more toxic amide or ester?
amides
what are the types of amide?
Articaine
Bupivacaine(Marcaine)
Cinchocaine/Dibucaine
Etidocaine
Levobupivacaine
Lidocaine (Xylocaine)/Lignocaine
Mepivacaine(Carbocaine)
Piperocaine
Prilocaine (EMLA cream=with lidocaine;2.5%ea)
Ropivacaine
Trimecaine
Bupivacaine(Marcaine)
Slow onset
Longer acting
Lidocaine (Xylocaine)/Lignocaine
Most popular
Can have epinephrine or not
Lower toxicity, rapid diffusibility, topical activity and chemical stability
Almost immediate
Last for 1 hour
Duration of action 90-120
Mepivacaine(Carbocaine)
Used for longer time frame surgeries
Slightly vasoconstrictive
Prilocaine (EMLA cream=with lidocaine;2.5%ea)
Mixture of lidocaine and prilocaine
Apply early takes up to a full hour
Relieve pain of venipuncture/injections
Superficial minor surgery
Pretreatment for infiltration anesthesia
Skin graft harvesting.
Do not apply EMLA cream:
* Near the eyes
* To broken or inflamed skin
* To open wounds
To more than 200 cm2 of skin – can in systemic effects in susceptible individuals
Last up to 4 hours
Absorbs in mucous membranes quicker
what is the mechanism of action of local anesthetics?
Small nerve fibers are more sensitive to actions
Most are vasodilation
Sensation of pain disappears first → followed by sense of cold and warmth → sense of touch → deep pressure → finally motor function
Which nerve fibers are most sensitive to actions of local anesthetics?
C type fiber
What are the pros/cons of epinephrine in local anesthetics?
Pro:
reduced bleeding
prolong duration of anesthia
hemostasis
Cons:
cut off blood supply
How quickly will epinephrine in a local anesthetic produce it’s full effect?
5 minutes
In what order do local anesthetics return sensation?
regain voluntary motor function, then sensation returns, and finally they can micturate (autonomic control)
What are the toxic effects of local anesthetics?
Local effects: redness, itching and swelling at the site of the inoculation
Cardiovascular reactions
* Hypotension
* Bradycardia
* Unconsciousness
* Mild cerebral hypoxia
Excitatory central nervous system
* Seizure
* Giddiness
* Respiratory failure
Allergic responses and Vasovagal syncope
* yawning, pallor, lightheadedness, wheezing, and hives to temporary loss of consciousness
Into which tissues is it not safe to inject local anesthetics containing epinephrine?
hands, penis, ear, nose, skin flaps with marginal viability, and dirty wounds
certain patients with diabetes, hypertension, heart block, or cerebrovascular disease
What is the purpose of adding sodium bicarbonate to local anesthetics?
to decrease the burning sensation of the anesthetics
Can sodium bicarbonate be safely added to local anesthetic products containing epinephrine? Why/why not? What are the effects?
yes mitigate the burning sensation, and has the added benefit of increasing the fraction of nonionized lipid soluble drug available
infiltration anesthesia
is accomplished with administration of the local anesthetic solution intradermally (ID), subcutaneously (SC), or submucosally across the nerve path that supplies the area of the body that requires anesthesia
field block
local anesthetic is infiltrated around the border of the surgical field, leaving the operative area undisturbed
What are the 2 advantages of a field block over an infiltration anesthesia?
longer duration of anesthesia and no distortion of the operative field
What are the various routes of administration of local anesthetics?
subcutaneous, intravenous, perineural, epidural and intrathecal
topical
What are the considerations when choosing an infiltration anesthetic?
location
cost
time needed
time of onset
What are the maximum allowable safe single doses of plain 1 % lidocaine and 0.25 % bupivacaine alone and with epinephrine?
Lidocaine: 4.5 mg/kg of 1%
(30 cc per average adult)
Bupivacine w/ epi: 400 mg/day
Bupivacine w/o epi: 3 mg/kg of 0.25%
(80 cc per average adult)
What alternatives to local anesthesia are available when a patient is apparently allergic to the ones commonly used?
Ethyl chloride
Vertical mattress sutures: advantages and disadvantages?
Pros
greater closure strength
better distribution of wound tenstion
Cons
tear
necrosis
scars
suture sets
gauges
needle holder
scissors
forcepts
