Surgical Prophylaxis

Question 1

What medications provide protection from postoperative GI bleeding?

Answer 1

H2 blockers, PPI

Question 2

What measures provide protection from postoperative atelectasis and pneumonia

Answer 2

Incentive spirometry, coughing, smoking cessation, ambulation

Question 3

What treatments provide protection from postoperative DVT?

Answer 3

LMWH; subcutaneous low-dose unfractionated heparin; sequential compression device for lower extremities; early ambulation

Question 4

What measures provide protection from wound infection?

Answer 4

Shower the night before surgery with chlorhexidine scrub; no razors for hair removal; ensure adequate skin prep in OR; do not close the skin in a contaminated case; ensure preoperative antibiotics in the bloodstream before incision; ensure no excess Bovie

Question 5

Why not use a razor to remove hair preoperatively?

Answer 5

Micro-cuts are a nidus for bacteria and subsequent wound infections

Question 6

How long should prophylactic antibiotics be given?

Answer 6

< 24 hours

Question 7

What treatment provides protection from oral or esophageal fungal infection during IV antibiotic treatment?

Answer 7

PO nystatin

Question 8

What measures prevent ventilator-associated pneumonia (VAP)?

Answer 8

Head of bed > 30 degrees; hand-washing; patient oral hygiene; avoidance of gastric overdistention

Question 9

What is the classic preoperative bowel prep?

Answer 9

1. Lower bacterial count in colon by catharsis (GoLYTELY or Fleets)
2. PO antibiotics (neomycin, erythromycin) preoperatively
3. Preoperative IV antibiotics with spectrum against anaerobes (e.g. Cefoxitin)

Question 10

Is there any evidence that a bowel prep decreases infections?

Answer 10

No

Question 11

What treatment provides protection from OPSS after splenectomy?

Answer 11

Immunization against H. flu, Streptococcus, Meningococcus, and penicillin when illness/fever occurs

Question 12

What treatment provides protection from endocarditis with faulty heart valve or prosthetic heart valve?

Answer 12

Antibiotics prior to dental procedure or any surgery

Question 13

What treatment provides protection from tetanus infection?

Answer 13

Tetanus toxoid (and tetanus immunoglobulins, if one or no previous toxoid with dirty wound)

Question 14

What treatment provides protection from alcohol withdrawal?

Answer 14

Chlordiazepoxide (Librium), also give Rally pack

Question 15

What treatment provides protection from Wernicke’s encephalopathy?

Answer 15

Rally pack (contains thiamine, folate, and magnesium)

Question 16

What is Wernicke’s encephalopathy?

Answer 16

Condition resulting from thiamine deficiency in patients with alcoholism, causing a triad of symptoms:

1. Confusion
2. Ophthalmoplegia
3. Ataxia

Question 17

What treatment decreases the risk of perioperative adrenal crisis in a patient on chronic steroids?

Answer 17

Stress-dose steroids (100 mg hydrocortisone administered preoperatively, continued postoperatively q8h, and then tapered off)