5. Pre-op Consultation

Question 1

What is the best way to communicate the location of a lesion of concern.

Answer 1

Clinical photographs

Diagrams with accurate measurements
using at least three anatomical landmarks as reference points

Question 2

What medical conditions affect cutaneous surgery?

Answer 2

1/ Pregnancy
- LA can cross the placental barrier and may accumulate preferentially in the fetus causing fetal bradycardia and central nervous system toxicity

2/ HTN
- increased intraoperative and postoperative bleeding and can complicate the process of wound reconstruction.

Question 3

Which anaesthetic agents are preferred if a patient is pregnant?

Answer 3

Lidocaine and prilocaine
- pregnancy category B agents

several studies examining the use of lidocaine during pregnancy have shown no increase in adverse fetal events or teratogenicity.

Question 4

Can Epinephrine be used with LA in Pregnancy?

Answer 4

Epinephrine

• pregnancy category C and should be used cautiously.

Question 5

What Abx are safe in pregnancy?

Answer 5

penicillin and cefalexin

penicillin-allergic patients, erythromycin base and azithromycin can be used

(all pregnancy category B)

Question 6

Why is HTN an issue for cutaneous surgery?

Answer 6

Increased intraoperative and postoperative bleeding and can complicate the process of wound reconstruction

Question 7

In regard to HTN, What BP threshold should you have to not operate?

Answer 7

SBP >170 mmHg and/or a
DBP >100 mmHg

Question 8

Which patients are at high risk of bacterial endocarditis from surgery?

and moderate risk?

Answer 8

• Prosthetic valves
• PHx of endocarditis
• Complex congenital heart disease
• surgically constructed systemic– pulmonary shunts

Moderate Risk:
- hypertrophic cardiomyopathy
- mitral valve prolapse with regurgitation

Question 9

What is the preferred prophylactic regimen for bacterial endocarditis?

Answer 9

2 g of amoxicillin given 1 h preoperatively (robinson)

Or:

cefalexin 2 g,
azithromycin 500 mg, or
clindamycin 600 mg given 1 h preoperatively

Question 10

What are the risk factors for endocarditis as a complication of surgery?

Answer 10

Procedure site:
- infected or eroded skin
- groin region
- oronasal mucosa

Patient factors:
- Prosthetic heart valve
- Personal Hx of endocarditis
- recent stents
- Congenital heart disease