Preoptimization
This is when a patient should hold aspirin preop
7 days prior to surgery
2 scenarios when cefazolin needs to be redosed
Surgery >4hrs
EBL >1500cc
These are 5 risk factors for VTE
•History of prior VTE
•Preexisting coagulopathic disease
•Age
•Obesity
•Cancer
•Medical comorbidities, ASA score
•Pregnancy
•Immobility
•Hormone exposure, e.g. estrogen therapy
•Smoking
•Mode of surgery
•Length of surgery
•Case complexity
•Case type
•General anesthesia
Your patient underwent vaginal hysterectomy and woke up on POD#1 with right foot drop. Which nerve was injured, how, an how quickly can she expect improvement?
Right common peroneal nerve
Lateral knee compression from stirrups
Weeks to months
Your 80 yr old patient POD#1 s/p TVH has SOB, O2 90% and HR 70. What do you do first?
Lung exam
1st imaging: CXR
These are the vitamins and supplements that need to be held prior to surgery
St John's Wort
garlic, ginkgo biloba, ginger, ginseng, evening primrose oil, omega-3 fatty acids (fish oil), vitamins C and E
This is the best antibiotic for a laparoscopic ovarian cystectomy
No antibiotics
Your patient had a PE. How long should you wait after the event before performing a benign ovarian cystectomy?
6 months
Injuries at entry, to bowel, and to urinary tract each occur at what rates in laparoscopic surgery?
Entry - 0.3%
Urinary tract - 0.3-0.8%
Bowel - 0.13-0.54%
The name of this incision
Cherney
Your patient is on warfarin for a-fib, but you are planning a laparoscopic hysterectomy. When should she hold her warfarin, and when can she restart?
Hold 3-5 days prior to surgery (goal INR = 1.5-2)
Restart 12-24 hrs after surgery
You are performing a hysterectomy and your patient reports a history of hives with penicillin. What agents and dose do you select?
Gentamycin 5mg/kg
Clindamycin 900mg
A 43-year-old healthy person undergoing a TLH/BS falls under which ACOG risk category for VTE?
High
This is how you repair a 2cm cystotomy
Confirm injury is not in the trigone
Primary repair in 2 layers
Catheter decompression 1-2 wks
Consider closed-suction drain, XR-cystogram
Your patient has a pacemaker and has a ruptured ectopic pregnancy. What is the best energy source to use for laparoscopic surgery?
Piezoelectric or ultrasonic (Harmonic scalpel)
This is who needs a preoperative CXR
Age > 60
ASA 3 or greater
History of cardiovascular disease
Undergoing extensive major surgery
You are doing a robotic myomectomy but your patient gets a rash with penicillin. What antibiotics do you select?
Not entering endometrial cavity = none
Entering cavity, rash without hives = 2g cefazolin
Your patient has a Caprini score of 5. What options can she be offered for perioperative VTE prophylaxis?
SCD
LDUH (5000 U every 8 hrs)
LMWH (40 mg enoxaparin daily or 5000 U dalteparin daily)
Your patient had a TAH & mentions at her postop visit that she has been having some weakness climbing stairs. On exam she has decreased sensation over the left medial thigh and calf, & decreased strength with hip flexion and knee extension. What nerve is injured, and how did it happen?
Left femoral nerve
Retractor placement
How long does it take vicryl to absorb, and when is its tensile strength at 50%?
absorbed at 56-70 days
50% tensile strength at 2-3 wks
You are planning LSC BSO for a postmenopausal adnexal mass. Your patient is taking metoprolol, amlodipine, lisinopril, and lasix. When should she stop taking each medicine?
metoprolol = B-blocker, continue incl day of surgery
amlodipine = Ca channel blocker, continue incl day of surgery
lisinopril = ACE-inhibitor, d/c night before surgery
lasix = diuretic, hold dose day of surgery
3 scenarios when you need doxycycline
Therapeutic abortions, Missed abortions
or D&S, D&E
Chromopertubation with hydrosalpinx
Placement of an intrauterine balloon
You did an abdominal cerclage on a pregnant patient, and now she is calling you with SOB, tachycardia, and a hot left leg. What imaging do you order first?
Left lower extremity doppler
2nd = CXR
3rd = V/Q vs CT-PE
Your patient underwent TLH/BSO, PPaLND for ovarian cancer. She calls with right labial numbness. Which nerve was injured?
Right genitofemoral nerve
Your patient is POD#7 from colpocleisis, and her daughter brings her to ED because she has been acting strange. Her labs show Na 125. What do you do?
admit
hypertonic saline 3%
correct 1/2 of deficit in 1st 8-12 hrs
restrict free water
(asymptomatic - can use isotonic saline)