NPO, Abx, Anesthesia

Question 1

Clean wound classification

Answer 1

<2% SSI risk
Does not enter resp, bowel, genital tracts
Ex. Breast biopsy

Question 2

Abx ppx for clean wound

Answer 2

Cefazolin

Question 3

Clean-contaminated wound classification

Answer 3

2-10% SSI risk

Major tracts entered under controlled conditions

Question 4

ppx abx for clean-contaminated

Answer 4

Cefazolin +/- anaerobes (metronidazole)

Question 5

Contaminated wound classification

Answer 5

10-20% SSI risk
Open accident wounds, breaks in sterile technique, gross spillage from GI tract
Ex. GSW

Question 6

Dirty wound classification

Answer 6

> 30% SSI risk
Existing infection with pus, perforation
Ex. I/D abscess

Question 7

Abx for dirty wound

Answer 7

Invanz (ertapenem)
Unasyn (ampicillin/sulbactam)
Zosyn (piperacillin/tazobactam)
Meropenem

Question 8

What do 1st generation cephalosporins cover?

Answer 8

Great G+, some G-

Add G- and anaerobe coverage if in a tract

Question 9

If you’re in a tract and need clean contaminated coverage, what drugs should you use? (Need to get G- and anaerobes)

Answer 9

Ceftoxitin or cefotetan alone
Clindamycin + aminoglycoside (mycin)
Cefazolin + metronidazole

Question 10

What does vancomycin cover?

Answer 10

MRSA (reserved)

Add G- if you need it

Question 11

Dosing of cefazolin is based on..

Answer 11

Weight
<120 kg 2gm
>120 kg 3 gm

Question 12

Timing of abx ppx

Answer 12

Should be within 60 min of first cut

FQs and vanc within 120 min

Question 13

When should you provide repeat dosing of ppx abx?

Answer 13

If duration of surgery is longer than 2 half lives

>1.5 L of blood loss

Question 14

When should you consider pre-op S. aureus screening?

Answer 14

Cardiac, ortho surgery
Immunocomp
Decolonization with mupirocin nasal ointment and chlorhexadine wash

Question 15

Airway assessment = LEMON

Answer 15

Look: general impression (beard, tongue)
Evaluate: 332 rule
Mallampati: class I better
Obstruction/obesity
Neck mobility

Question 16

IV anesthetic agents

Answer 16

Propofol
Etomidate
Ketamine

Question 17

Inhalant anesthetics

Answer 17

Sevoflurane
Desflurane
NO

Question 18

Neuromuscular blockade agents (NMBA)

Answer 18

Depol: SCh

non-depol: rocuronium, vecuronium, pancuronium

Question 19

Uses and contra of succinylcholine

Answer 19

Use if you need airway ASAP

SE: malignant hyperthermia hx, neuromuscular dz, rhabdo, burns 72+ hours old, hyperkalemia

Question 20

Anesthesia induction progression

Answer 20

1. Midazolam
2. OR: fentanyl/lidocaine
3. 5 min later: propofol + lidocaine/NMBA

Question 21

How is anesthetic maintenance accomplished?

Answer 21

Inhalation agent
NO
Opioid
Muscle relaxant

Question 22

How can you mitigate the hyperresponsiveness of emergence?

Answer 22

HTN, tachy, bronchospasm can be mitigated with B blockers, lidocaine and narcotics

Question 23

How to do spinal regional anesthesia and AE?

Answer 23

L3/L4 or L4/L5 into subarachnoid

AE: hemodynamic changes, spinal headache

Question 24

How to do epidural regional anesthesia?

Answer 24

Small gauge catheter into epidural space - can be placed anywhere

Can have repeat dosing
Need higher dosing
If gets in CSF - CV collapse