Intraop and ERAS

Question 1

Pathophys of Oliguria in robotic surgery

Answer 1

1. Trendelenburg: inc intraabdominal pressure -> activates RAAS -> fluid retention, dec GFR -> oliguria
2. penumoperitoneum: inc intraabdominal pressure

Question 2

intraop trocar placement to avoid inf. epigastric injury

Answer 2

2cm cephalad, medial to ASIS

Question 3

hysteroscopy medim for monopolar device

Answer 3

electrolyte-poor (glycine, sorbitol, mannitol)

Question 4

max fluid deficit of electrolyte-poor fluid

Answer 4

1000mL

Question 5

max fluid deficit of electrolyte-containing fluid

Answer 5

2500mL

lower in pts with heart failure risk

Question 6

hysteroscopy medim for bipolar device

Answer 6

normal saline, LR

Question 7

arteries that supplies ant. abdominal wall

Answer 7

1. inf. epigastric
2. musculophrenic
3. deep circumflex iliac

Question 8

Bladder layers (in to out)

Answer 8

trans. epithelium
lamina propria
submucosa
detrusor muscle
adventitia (serosa)

Question 9

Abx dose for Hysterectomy

Answer 9

ancef 2g

3g if >120kg

Question 10

Ancef for which GYN cases?

Answer 10

1. hysterectomy
2. colporrhaphy
3. sling
4. +/- laparotomy w/o bowel or vaginal entry

Question 11

Doxy for which GYN cases? dose?

Answer 11

1. pregnancy-related D&C (200mg)
2. HSG, chromopertubation (w/ hx of PID, abn tubes) (100mg BID for 5d)

Question 12

Vicryl also known as

Answer 12

polyglactin

Question 13

PDS also known as

Answer 13

polydioxanone

Question 14

poliglecaprone 25 a.k.a.

Answer 14

monocryl

Question 15

name synthetic sutures

Answer 15

PDS
vicryl
monocryl

Question 16

name monofilament sutures

Answer 16

PDS
chromic gut
monocryl

Question 17

PDS 50% tensile strength

Answer 17

~1mo

Question 18

Vicryl 50% tensile strength

Answer 18

~2wks

Question 19

chromic gut 50% tensile strength

Answer 19

~1wk

Question 20

monocryl 50% tensile strength

Answer 20

~1wk

Question 21

name braided suture

Answer 21

vicryl

Question 22

Describe primary wound closure

use

Answer 22

simple closure w/ suture, staples

use: clean, uninfected wounds

Question 23

Describe secondary closure

use:

Answer 23

wet to dry dressings

use: wound infections

Question 24

Describe tertiary closure

use

Answer 24

leaving wound open to see if infxn opens

in high-risk cases (trauma w/ concrn for abdominal complartment s/d)

Question 25

ERAS steps to prevent postop pneumnia

Answer 25

elevate head of bed suction of secretions use of OG tubes (avoid NG) early ambulation

Question 26

periop metformin mgmt | reason?

Answer 26

held AM preop -> start when eating well | inc risk renal hypoperfusion, lactic acidosis, tissue hypoxia

Question 27

periop mgmt short-acting insulin | why

Answer 27

held AM of surgery | inc risk hypoglycemia

Question 28

periop mgmt long-acting insulin | why

Answer 28

1/2-2/3 of usual dose

Question 29

periop mgmt int-acting insulin

Answer 29

normal dose night before

Question 30

which DM meds to hold on AM of surgery

Answer 30

sulfonylureas (glyburide) thiazolidediones (-"zones") metformin sodium-glucose cotransport 2 inhib (i.e. Jardiance... -"flozins") | inc risk of hypoglycemia hypovolemia

Question 31

nerve to avoid during Pfannenstiel? | location ## Footnote numbness where?

Answer 31

iliohypogastric (to some degree, ilioinguinal, too) | lateral rectus muscles ## Footnote above incision w/ apex at level of umbilicus

Question 32

nerves affected by deep retraction along psoas muscle? | sensation fx?

Answer 32

lateral femoral cutaneous n. genitofemoral n. | LFC: ant, lat thigh sensation genitofemoral: labia/scrotum, inner thigh

Question 33

albumin: origin fxn

Answer 33

origin: liver fxn: maintain colloid osmotic pressure

Question 34

serum albumin level indicating poor periop outocme sin elderly?

Answer 34

<3g/dL (absence of AKI, hepatic fialure) | marker of negative catabolic state

Question 35

Ppx hysterectomy Abx if severe PCN allergy

Answer 35

clinda + gent or flagyl + gent

Question 36

iliohypogastric nerve root

Answer 36

L1

Question 37

ilioinguinal nerve root

Answer 37

L1

Question 38

Preop pt: antiseptic soap? shave?

Answer 38

antiseptic soap: yes shave? no (avoid)

Question 39

primary (umbilical) trocar angle: obese non-obese

Answer 39

obese: 60deg non-obese: 45deg

Question 40

chromic catgut: complete absorption

Answer 40

90days

Question 41

polyglactin 910 complete resorption

Answer 41

28d | vicryl

Question 42

polyglactin 910 rapide complete resorption

Answer 42

42d | vicryl rapide (this is not an intuitive name... lasts longer time)

Question 43

Poliglecaprone 25 complete resorption

Answer 43

90d (similar to catgut) | 90d

Question 44

Polydioxanone complete resorption time

Answer 44

180d | PDS