Podcast
Questions and Answers
Which antibiotic is preferred for surgical prophylaxis due to its effectiveness against skin flora?
Which antibiotic is preferred for surgical prophylaxis due to its effectiveness against skin flora?
Antibiotics should only be used in contaminated surgical procedures.
Antibiotics should only be used in contaminated surgical procedures.
False
What are the predominant organisms causing surgical site infections after clean procedures?
What are the predominant organisms causing surgical site infections after clean procedures?
Skin flora including S.aureus and coagulase-negative staphylococci.
The type of surgical operation where the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions is called a ______.
The type of surgical operation where the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions is called a ______.
Signup and view all the answers
Match the following types of surgical operations with their descriptions:
Match the following types of surgical operations with their descriptions:
Signup and view all the answers
In which scenario is vancomycin advised as a prophylactic therapy?
In which scenario is vancomycin advised as a prophylactic therapy?
Signup and view all the answers
Parenteral antibiotic administration is not preferred for achieving suitable tissue concentrations.
Parenteral antibiotic administration is not preferred for achieving suitable tissue concentrations.
Signup and view all the answers
What type of antimicrobial coverage is typically included in surgical prophylaxis?
What type of antimicrobial coverage is typically included in surgical prophylaxis?
Signup and view all the answers
What is a common side effect of Vancomycin when used intravenously?
What is a common side effect of Vancomycin when used intravenously?
Signup and view all the answers
Ciprofloxacin is particularly effective against Gram-positive bacteria.
Ciprofloxacin is particularly effective against Gram-positive bacteria.
Signup and view all the answers
What is Metoclopramide primarily indicated for?
What is Metoclopramide primarily indicated for?
Signup and view all the answers
Ciprofloxacin should not be used for extit{______} pneumonia.
Ciprofloxacin should not be used for extit{______} pneumonia.
Signup and view all the answers
Match the drug with their primary common side effects:
Match the drug with their primary common side effects:
Signup and view all the answers
Which of the following bacteria is Ciprofloxacin particularly active against?
Which of the following bacteria is Ciprofloxacin particularly active against?
Signup and view all the answers
Extrapyramidal effects from Metoclopramide are more common in older adults.
Extrapyramidal effects from Metoclopramide are more common in older adults.
Signup and view all the answers
What should be done if a patient experiences tinnitus while on Vancomycin?
What should be done if a patient experiences tinnitus while on Vancomycin?
Signup and view all the answers
What is the preferred route of administration for prophylactic antibiotics in most surgeries?
What is the preferred route of administration for prophylactic antibiotics in most surgeries?
Signup and view all the answers
Postoperative continuation of antimicrobial prophylaxis beyond wound closure for cardiothoracic surgery is recommended.
Postoperative continuation of antimicrobial prophylaxis beyond wound closure for cardiothoracic surgery is recommended.
Signup and view all the answers
What is the goal of antimicrobial dosing for surgical prophylaxis?
What is the goal of antimicrobial dosing for surgical prophylaxis?
Signup and view all the answers
The recommended administration time for most prophylactic antibiotics is within _____ minutes of skin incision.
The recommended administration time for most prophylactic antibiotics is within _____ minutes of skin incision.
Signup and view all the answers
Match the type of thromboprophylaxis with their descriptions.
Match the type of thromboprophylaxis with their descriptions.
Signup and view all the answers
Which of the following agents can be used for oral bowel preparation?
Which of the following agents can be used for oral bowel preparation?
Signup and view all the answers
Patients with a history of deep vein thrombosis are not at risk for developing DVT during major surgery.
Patients with a history of deep vein thrombosis are not at risk for developing DVT during major surgery.
Signup and view all the answers
What happens if an operation exceeds two half-lives of the selected antimicrobial?
What happens if an operation exceeds two half-lives of the selected antimicrobial?
Signup and view all the answers
After surgery, if no prophylaxis is given, _____% of patients over 40 years of age will develop DVT.
After surgery, if no prophylaxis is given, _____% of patients over 40 years of age will develop DVT.
Signup and view all the answers
Which of the following is considered a disadvantage of combination antimicrobial therapy?
Which of the following is considered a disadvantage of combination antimicrobial therapy?
Signup and view all the answers
Match the type of surgery with the appropriate antibiotic preparation:
Match the type of surgery with the appropriate antibiotic preparation:
Signup and view all the answers
What is the role of fondaparinux in thromboprophylaxis?
What is the role of fondaparinux in thromboprophylaxis?
Signup and view all the answers
Antibiotic administration is typically reliable when given orally for surgical prophylaxis.
Antibiotic administration is typically reliable when given orally for surgical prophylaxis.
Signup and view all the answers
When preparing for emergency colon surgery, a _____ catheter is used for intraoperative lavage.
When preparing for emergency colon surgery, a _____ catheter is used for intraoperative lavage.
Signup and view all the answers
What is the recommended fluid maintenance for children under 24 hours?
What is the recommended fluid maintenance for children under 24 hours?
Signup and view all the answers
Pregnant women should not receive IV fluids during surgery.
Pregnant women should not receive IV fluids during surgery.
Signup and view all the answers
What fluid is recommended for resuscitation in cases of acute blood loss?
What fluid is recommended for resuscitation in cases of acute blood loss?
Signup and view all the answers
Patients with liver failure should avoid using _______ for maintenance.
Patients with liver failure should avoid using _______ for maintenance.
Signup and view all the answers
Match the following medications with their primary usage:
Match the following medications with their primary usage:
Signup and view all the answers
What is the appropriate fluid challenge volume for a patient with heart failure?
What is the appropriate fluid challenge volume for a patient with heart failure?
Signup and view all the answers
Severe burns require minimal fluid resuscitation.
Severe burns require minimal fluid resuscitation.
Signup and view all the answers
What are the common side effects of Tramadol?
What are the common side effects of Tramadol?
Signup and view all the answers
_____ patients on steroids may require additional corticosteroid cover during surgery.
_____ patients on steroids may require additional corticosteroid cover during surgery.
Signup and view all the answers
Which drug is used to inhibit gastric acid secretion?
Which drug is used to inhibit gastric acid secretion?
Signup and view all the answers
Ceftriaxone is a third generation cephalosporin with greater activity against Gram-positive bacteria than cefuroxime.
Ceftriaxone is a third generation cephalosporin with greater activity against Gram-positive bacteria than cefuroxime.
Signup and view all the answers
What is the primary role of vancomycin?
What is the primary role of vancomycin?
Signup and view all the answers
Match the drugs with the conditions they treat:
Match the drugs with the conditions they treat:
Signup and view all the answers
_____ should be given prior to induction in major surgery for patients on corticosteroids.
_____ should be given prior to induction in major surgery for patients on corticosteroids.
Signup and view all the answers
Study Notes
Surgical Prophylaxis
- Prophylactic antibiotics are administered before contamination of sterile tissues to prevent infection.
- Common surgical pathogens:
- Clean procedures: Skin flora, including S.aureus and coagulase-negative staphylococci
- Clean-contaminated procedures: Gram-negative rods, enterococci, and skin flora
- Antimicrobial selection:
- Depends on procedure type, likely pathogens, and antimicrobial safety and efficacy.
- Gram-positive coverage is typically included.
- Parenteral administration is preferred for reliable tissue concentrations.
- First-generation cephalosporins (e.g., cefazolin) are commonly used.
- Vancomycin can be used for procedures involving prosthetic implants with high MRSA rates.
- Clindamycin can be used instead of cefazolin for β-lactam hypersensitivity.
Types of Surgical Operations
- Clean: Uninfected wounds, no inflammation, no entry to respiratory, alimentary, genital, or urinary tracts.
- Clean-contaminated: Entry to respiratory, alimentary, genital, or urinary tracts under controlled conditions.
- Contaminated: Open, fresh, accidental wounds, or significant breaks in sterile technique.
- Dirty: Preexisting infection (abscess, pus, or necrotic tissue).
Principles of Antimicrobial Prophylaxis
- Route of administration: Intravenous is preferred for reliable serum and tissue concentrations.
- Oral administration is used in some bowel procedures and can be used adjunctively.
- Timing of first dose: Most guidelines recommend administration within 60 minutes of skin incision.
- Fluoroquinolones and glycopeptides should be started 120 minutes before incision.
- Dosing: The goal is to maintain antibiotic concentrations above the MIC of suspected organisms for the duration of the operation.
- Duration: Prophylaxis should not exceed 24 hours (24-48 hours for cardiothoracic surgery).
Combination Antimicrobial Therapy
- Broadens coverage, achieves synergistic activity, and prevents resistance.
- Disadvantages: Increased cost, drug toxicity, and risk of superinfection with resistant bacteria.
Thromboprophylaxis
- Deep venous thrombosis (DVT) is common in patients over 40 undergoing major surgery.
- Prophylaxis is recommended to prevent DVT and pulmonary thromboembolism (PTE).
- Types of thromboprophylaxis: Mechanical devices (e.g., TED stockings) and drugs (e.g., heparin, LMWH, fondaparinux).
Risk Groups for DVT
- All patients are at risk.
- Assessment for risk factors is required on admission and after 24 hours in hospital.
- Procedure factors: Prolonged anesthesia, lower limb or pelvic surgery
- Patient factors: Immobility, malignancy, age, dehydration, obesity, and medical conditions.
- Bleeding risks should be balanced against thromboprophylaxis.
Preoperative Bowel Preparation
- Elective colon operation:
- Mechanical preparation: Whole gut lavage or standard cleansing
- Antibiotic preparation: Oral or parenteral antibiotics
- Emergency colon preparation:
- Intraoperative lavage
- Parenteral antibiotics
Intravenous Fluid Therapy
- Fluids should be given if oral intake is insufficient.
- Aim for 2500mL fluid containing 100mmol Na+ and 70mmol K+ per 24 hours.
- Special cases:
- Acute blood loss: Resuscitate with colloid or saline until blood is available
- Children: Dextrose-saline for fluid management
- Elderly: Use IV fluids with care to avoid overload
- GI losses: Replace lost fluid and electrolytes
- Heart failure: Use IV fluids with caution
- Liver failure: Use salt-poor albumin or blood for resuscitation
- Acute pancreatitis: Aggressive fluid resuscitation is needed
- Poor urine output: Give a fluid challenge and ensure catheter function
Surgery in Those on Steroids
- Patients on steroids may not have a normal adrenal response to surgery due to HPA axis suppression.
- Extra corticosteroid cover may be required depending on the type of surgery.
- Consider covering for patients taking >5mg/d of prednisolone (or equivalent) for >2 weeks or those who have had their dose reduced recently.
- There is potential for HPA suppression in patients taking high-dose inhaled or topical corticosteroids.
Drugs Commonly Used in Surgical Operations
-
Analgesics:
- Tramadol hydrochloride: Opioid analgesic with fewer side effects compared to other opioids.
- Acetaminophen (Paracetamol): Non-opioid analgesic for mild to moderate pain.
-
Gastrointestinal Drugs:
- Ranitidine: H2-receptor antagonist for reducing gastric acid output.
- Omeprazole: Proton pump inhibitor for inhibiting gastric acid secretion.
-
Antibiotics:
- Ceftriaxone and Cefotaxime: Third-generation cephalosporins with broad-spectrum activity.
- Meropenem: Carbapenem with good activity against Pseudomonas aeruginosa.
- Vancomycin: Glycopeptide antibiotic with bactericidal activity against Gram-positive bacteria.
- Ciprofloxacin: Quinolone active against both Gram-positive and Gram-negative bacteria.
-
Anti-emetics:
- Metoclopramide: Dopamine receptor antagonist for nausea and vomiting.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers the key concepts of surgical prophylaxis, including the use of prophylactic antibiotics to prevent infection in various surgical procedures. You will learn about common surgical pathogens, antimicrobial selection, and the types of surgical operations based on cleanliness. Test your knowledge to ensure best practices in surgical care.
