Prophylaxis (VTE, antibiotics)

Question 1

To prevent venousthromboembolism (VTE), DVT prophylaxis should be started as indicated. What does this include?

Answer 1

• Graduated compression stockings
• express sleeves (mechanical VTE e.g. machine power pumped up stockings?
• low molecular weight heparin (LMWH) e.g. enoxaparin 20mg/d SC –> start 2h pre op
  
  • NB: this LMWH is increased to 40mg/d in major risk surgery
• OR 5000U heparin SC 2h pre-op then every 8-12h SC for 7d or until ambulant

Question 2

Why are antibiotics used in surgery prophylaxis?

Answer 2

• They counter the risk of wound infection [which is ~20% in elective GI surgery and ~60% in emergency surgery]
• infection –> sepsis –> haemorrhage, wound dehiscence (splitting, bursting open)
• –> Abx are also given if there is infection elsewhere

Question 3

Why is time administration of antibiotics for surgical prophylaxis importand and when is the ideal time?

Answer 3

Aministration must be times correctly to maximise skin concentration

• ~2h before:
  
  • Oral
  • Metronidazole PR
• ~ 30min prior to surgery
  
  • IV abx

Use abx which will kill anaerobes and coliforms & practise strictly sterile surgical technique

Question 4

What risk does not using peri-operative supplemental oxygen decrease?

Answer 4

The incidence of surgical wound infections

Question 5

What surgery is this an example abx regimen for?

e.g. (using abx which will kill anaerobes and coliforms e.g. g-ve bacteria)

single dose IV cefuroxime 1.5mg + metronidazole 500mg

or

gentamicin 1.5mg/kg + metronidazole 500mg

or

co-amoxiclav 1.2g alone (amox + clavulanic acid)

Answer 5

Appendicectomy; colorectal resections & open biliary surgery:

Question 6

What tye of surgery this an example abx regimen for?

1x dose IV gentamicin

or

cefurozime

or

co-amoxiclav

Answer 6

oesophageal or gastric surgery

Question 7

What surgery is this an abx regimine for?

1x dose of IV cefuroxime

or

flucloxacillin 1-2g + gentamicin;

add metronidazole if risk of anaerobes

Answer 7

VASCULAR SURGERY (fluclox for skin)

add metronidazole if risk of anaerobes e.g. amputations, gangrene, diabetes

Question 8

1x dose of IV cefuroxime or flucloxacillin 1-2g + gentamicin;

add metronidazole

add teicoplanin or vancomycin

What surgery does this abx regimin apply to?

Answer 8

(vascular surgery) but + vanc or teicoplanin for MRSA for HIGH RISK PATIENTS

(met is for if risk of anaerobes e.g. gangrene, diabetes)

Question 9

What are the benefits of bowel preparation pre-surgery &/VS colonoscopy?

Answer 9

Reduce risk of anastomotic leakage & septic complications in colorectal surgery;

pre-colonoscopy it provides obvious benefit for visualisation

Question 10

• What are the complications of bowel prep for surgery/colonoscopy?

Answer 10

Complications:

• Liquefying bowel contents which are spilled during surgery
• Electrolyte loss leading to hyponatraemia & seizures
• A higher rate of post-operative anastomotic leakage
• Perforation
• Dehydration

Question 11

What should you do for the patient and surgeon if the pt has hepatitis or HIV?

Answer 11

Discuss the risk of hepatitis and HIV to patient and surgeon

–> and the role of protection for the surgeon and patient to spread of such infections