Operative Process

Question 1

what are the NPO pre-op guidelines?

Answer 1

no solid food 6-8 hours before surgery

no clears within 2 hours pre-op

(generally, nothing to eat or drink after midnight)

exception: post-pyloric tube feeds can continue

Question 2

What is the definition of an SSI?

Answer 2

infection related to operative procedure that occurs at or near surgical site within 30 days of the procedure, or 90 if prosthetic materials implanted

Question 3

What is the most common cause of SSIs (30%)?

Answer 3

Staph. aureus

of these, nearly 1/2 contain MRSA isolates

Question 4

What antibiotic is good prophylaxis for clean-contaminated wounds that provides gram + skin flora coverage (strep, MSSA) and some gram -ve coverage

Answer 4

1st generation cephalosporin - cefazolin

Question 5

Procedures that are entering the GI, oropharynx, GU or biliary tree require added gram - and anerobic coverage with what?

Answer 5

Cefoxitin or cefotetan

clindamycin plus aminoglycoside

cefazolin plus metronidazole

Question 6

when would you consider using vancomycin for prophylaxis?

Answer 6

• hospitals with frequent MRSA SSIs
• pts with known MRSA colonization
• High risk for MRSA: nursing home, recent hosp.

Question 7

when should antibiotic prophylaxis be administered?

Answer 7

within first 60 minutes of surgical incision

(longer for vanco and fluroquinalones)

repeat dosing if duration of procedure lasts longer than 2 half lives or excess blood loss (>1.5 L)

Question 8

when should you consider screening pre-op for S. aureus?

Answer 8

procedures at high risk for complications if an infection develops - cardiac or orthopedic procedures

Question 9

What is the protocol for surgical site marking?

Answer 9

1. pre-procedure verification process
2. marking the procedure site
3. time out (final verification)

Question 10

what are the guidelines for surgical marking?

Answer 10

1. mark the site - must do it when there is more than one possible location
2. should be done by the surgeon, ideally with patient involvement
3. unambiguous and standardized within and organization, made near the procedure site with a marker permanent enough to be visualized after surgical prep.

Question 11

what are the 5 things to look for in a pre-op airway assessment?

Answer 11

LEMON

Look

Evaluate 3-3-2

Mallampati (< or equal to 3)

Obstruction/osbesity

Neck mobility

Question 12

what happens during the pre-incision time out?

Answer 12

all team members for procedure must agree on the correct patient ID, correct site, and procedure to be done

complete documents

Question 13

What are the three phases of general anesthesia?

Answer 13

Induction

Maintenance

Emergence

Question 14

what’s good and bad about total IV anesthesia?

Answer 14

lowers post op nausea and vomiting

increases time to extubation and return to cognitive fxn