SURGERY ROOM INTRODUCTION: 11, 12, 13, 14, 15, 16, 17, 18

Question 1

what products can be used for cold sterilization?

Answer 1

-Glutaraldehyde
-Ortho-phthaldeidehyde
-Hydrogen peroxide
-Peracetic acid (6 days)

Question 2

temperature for steam sterilization

temperature for dry sterilization

Answer 2

121° for 30 min
132° for 4 min

160° for 2 h

Question 3

name some other methods of cold sterilization

Answer 3

-ethylene oxide
-ozone
-plasma
-vaporized hydrogen peroxide
-performic acid, microwave radiation, high temperature bead sterilizers, formaldehyde (not approved by FDA)

Question 4

name 4 different types of rongeurs

Answer 4

Stille-Luer (double hinge, bigger)
Ruskin (double hinge, smaller)
Lempert (classica)
Kerrison

Question 5

debakey name 2 different instruments, what are them?

Answer 5

1) non crushing forceps
2) thumb forceps

Question 6

name 5 different bone holding forceps

Answer 6

1)Kern
2)Lane
3)Verbrugge
4)reduction forceps with speed lock (screw and nut)
5)reduction forceps with ratchet

Question 7

is hair removal suggested before surgery or in the preoperative period?

Answer 7

preoperative period (within 4 hours), it reduces surgical site infection

Question 8

what are the 3 possible techniques for monitoring an hospital surgical infection rate?

Answer 8

1) active surveillance: gathering specific data for infection control purposes
2) using data already available (surgical records, bacterial cultures…)
3) syndrome surveillance: analysis of a certain clinical sign, that may be indicator of the disease (es: fever, diarrhea, coughing for infectious disease)

Question 9

what data should be evaluated to assess a surgical infection outbreak?

Answer 9

1) how many infections
2) how many procedures
3) what type of procedure
4) when the problem started (sudden or gradual)
5) what organism
6) commonalities? (personell, location, equipment)

Question 10

what are the 2 possible way to degradate a suture biologically?

Answer 10

1) enzymatic
2) hydrolitic

Question 11

factors that can influence absorption rates for sutures

Answer 11

-exposure to urine: in sterile urine PDS lost all it’s strength in 3 days, poliglicoic acid in 7 days. if urine are infected PDS in 1 day,
-pH: sutures with a glicolyde component (poliglecaprone, poliglyconato, glycomer) decradate in alkaline environment, dioxanone component (PDS) in an acid environment.

Question 12

rapidly absorbed sutures

Answer 12

1) poliglycolic acid (DEXON): 60-90 days. 50% strength at 2-3 weeks
2) polyglactin (VICRYL): same, 50% 2-3 weeks
3) poliglecaprone (MONOCRYL): 90-120 days completely absorbed, 50% strength 1 week, 80% 2 weeks

Question 13

slowly absorbed sutures

Answer 13

1) polydioxanone: 50% strength 5-6 weeks
2) polyglyconate: 50% strength 4-5 weeks
3) glycomer 631: 50% 2-3 weeks

Question 14

automatic stapler: different staples measure and applications

Answer 14

-4,8 mm staples compress to 2 mm
-3,5 mm staples compress to 1,5 mm
-2,5 mm staples compress to 1 mm (vascular applications)

Question 15

HALDSTED surgical principles

Answer 15

1) handle tissue gently
2) control emorrage
3) observe strictly aseptic technique
4) preserve blood supply
5) eliminate dead space
6) appose tissue accurately

Question 16

4 different methods to hold a needle holder

Answer 16

1) tripod (classica)
2) thenar (mine)
3) palmed
4) pencil (castrovejo)

Question 17

difference between CONNEL, CUSHING, LEMBERT

Answer 17

Cushing: U orizzontale, 1/2 spessore
Connel: U orizzontale, tot spessore
Lembert: U verticale, 1/2 spessore

Question 18

gold standard throws to for a secure knot

Answer 18

5 throws

Question 19

3 principles to obtain surgical hemostasis

Answer 19

1) blood flow reduction
2) tropical hemostatic agents
3) antifibrinolytics

Question 20

blood flow reduction techniques

Answer 20

1) pressure/tamponade: minor hemorrhage will usually end in 2-3 min. abdominal counter pressure bandage can lead to intracranial and intrathoraci hypertension
2) topical vasoconstrictors: epinephrine, adrenaline, ephedrine
3) hypotension, hypothermia, reduced perfusion: reduced perfusion can be obtained with a tourniquet, Pringle maneuver for hepatic artery and PV, also carotid, renal, femoral arteries, aorta, tumor arterial supply, vena cava can be temporary be occluded

Question 21

tropical hemostatic agents

Answer 21

1) mechanical: gelatins, bovine collagen, oxidized regenerated cellulose, polysaccharide spheres, bone wax and Ostene
2) active: thrombin, alginates
3) emostatic sealants: fibrin, synthetic sealants,

Question 22

antifibrinolytics

Answer 22

1) serine protease inhibitor: apoprotein, risk of thromboembolism
2) lysine analogues: tranexamic acid

Question 23

other miscellaneous products to obtain hemostasis

Answer 23

1)desmopressin ( stimulates release of vWF and F8 from endothelium)
2) ethamsylate. in dogs dosage up to 200 mg/Kg.
3) hemostatic polimeri like zeolite, chitosan