Surgical Prophylaxis, C29 P181-183

Question 1

What medications provide
protection from postoperative
GI bleeding?
P181

Answer 1

H(2) blockers, PPI (proton-pump inhibitor)

Question 2

What measures provide
protection from postoperative
atelectasis/pneumonia?
P181

Answer 2

Incentive spirometry, coughing, smoking

cessation, ambulation

Question 3

What treatments provide
protection from postoperative
DVT?
P181

Answer 3

Low-molecular-weight heparin (LMWH),
subcutaneous low-dose unfractionated
heparin, sequential compression device
(SCD) for lower extremities, or both;
early ambulation

Question 4

What measures provide
protection from wound
infection?
P182

Answer 4

Shower the night before surgery with
   chlorhexidine scrub
Never use a razor for hair removal
   (electric shavers only)
Ensure adequate skin prep in O.R.
Do not close the skin in a contaminated case
Ensure preoperative antibiotics in the
   bloodstream before incision
Ensure no excess Bovie (necrotic tissue)

Question 5

Why not use a razor to
remove hair?
P182

Answer 5

Micro cuts are a nidus for bacteria

and subsequent wound infection

Question 6

How long should “prophylactic
antibiotics” be given?
P182

Answer 6

< 24 hrs

Question 7

What treatment provides protection
from oral/esophageal
fungal infection during IV
antibiotic treatment?
P182

Answer 7

PO nystatin

Question 8

What measures prevent
ventilator-associated
pneumonia (VAP)?
P182

Answer 8

Head of bed 30, handwashing, patient
oral hygiene, avoidance of gastric
overdistention

Question 9

What is the classic
preoperative “bowel prep”?
P182

Answer 9

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

Question 10

Is there any evidence that a
“bowel prep” decreases
infections?
P182

Answer 10

NO

Question 11

What treatment provides
protection from OPSS after
splenectomy?
P182

Answer 11

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

Question 12

What treatment provides
protection from endocarditis
with faulty heart valve or
prosthetic heart valve?
P182

Answer 12

Antibiotics prior to dental procedure or

any surgery

Question 13

What treatment provides
protection from tetanus
infection?
P183

Answer 13

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

Question 14

What treatment provides
protection from EtOH
withdrawal?
P183

Answer 14

Chlordiazepoxide (Librium®), also give

Rally pack

Question 15

What treatment provides
protection from Wernicke’s
encephalopathy?
P183

Answer 15

Rally pack (a.k.a. banana bag because
the IV is yellow with the vitamins in it);
pack includes thiamine, folate, and
magnesium

Question 16

What is Wernicke’s
encephalopathy?
P183

Answer 16

Condition resulting from thiamine
deficiency in patients with alcoholism,
causing a triad of symptoms; think “COA”:
1. Confusion
2. Ophthalmoplegia
3. Ataxia

Question 17

What treatment decreases
the risk of perioperative
adrenal crisis in a patient on
chronic steroids?
P183

Answer 17

“Stress-dose” steroids: 100 mg hydrocortisone
administered preoperatively,
continued postoperatively q 8 hours,
and then tapered off