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  The first prophylactic antibiotic dose should provide a sufficient antibiotic serum level throughout the surgery to combat organisms   The first dose be timed to occur within 60 minutes before the surgical incision is made.   If a fluoroquinolone or vancomycin is chosen for administered within 120 minutes of the start of   For most surgeries, the use of prophylactic antibiotics should end within 24 hours after   Cefazolin or cefuroxime are suggested for prophylactic antibiotics up to 72 hours to Cardiothoracic Cefazolin or cefuroxime; if beta 72-hour duration
lactam allergy, vancomycin or advocated by some, but
clindamycin
24 hours is likely to be
adequate
Vascular
Cefazolin or cefuroxime; if beta
lactam allergy, vancomycin
with or without gentamicin, or
clindamycin
Oral: neomycin, with
Combination of oral and
erythromycin base or
parenteral prophylaxis
metronidazole
may decrease infection
rates
Adapted with permission from Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004,38:1707.   Adapted with permission from Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004,38:1707.   Incidence of incarceration ~10% among   Cannot be reduced into the abdominal   Strangulated hernias have incarcerated   Frequently, intense pain is caused by   Incarcerated inguinal hernias present with abdominal distention, pain, nausea, and vomiting due to intestinal obstruction.   Plain abdominal X-rays may verify intestinal obstruction in cases of incarceration.   Etiology for extensive resection:   Congenital anomalies leading to short bowel syndrom include –   Midgut volvulus w/ intestinal necrosis   Extensive resection due to malignancy.   Resection resulting in less than 120cm of intact   Resection of up to 50% of smal bowel is   Resection of up to 70% is tolerated if terminal   Infants may tolerate upto 85% of smal bowel   Loss of the ileocecal valve results in rapid emptying of enteral contents into the colon and reflux of colonic bacterial flora into smal bowel.   The entire jejunum can be resected without serious adverse nutritional sequela.  Cel ular hyperplasia and bowel hypertrophy occur over a 2- to 3-year period, increasing the absorptive surface area.  Fat absorption is most likely permanently   Hyperoxaluria & Nephrolithiasis   Gastric hypersecretion – in early postop period. Increased acid load may injure distal bowel mucosa  hypermotility & impaired absorption.   Cholelithiasis – altered bilirubin metabolism after ileal resection  increased risk of pigmented gal stones stones that is 2nd to a decreased bile salt pool. TPN also may lead to increased risk of cholelithiasis.   Hyperoxaluria & Nephrolithiasis –  Excessive fatty acids within the colonic lumen  Unbound oxalate that normal y is made insoluble by Ca-binding and is excreted in feces is thus, readily absorbed.  This results in hyperoxaluria and calcium  Caused by rapid intestinal transit.  Presence of hyperosmolar enteric contents.  Disruption of enterohepatic bile acid  Fat absorption is most severly impaired by  Loss of ileocecal valve permits reflux of  Intestinal dysmotility increases colonization.  Bacterial overgrowth & change in flora results in pH alteration & deconjugation of bile salts.  This results malabsorption, fluid loss,   Irreversibly acetylates cyclooxygenase   Results in inhibiting plt synthesis of   Higher doses than > 80 – 160mg PO / day   GPC – streptoccocci, syphilis,   GPR - Neisseria m., C. perfringens,   Beta-hemolytic strep, antrax   Not effective for Staph or Enterococcus   Ampicil in/amoxicil in: PCN + Enterococcus coverage   Unasyn: PCN + GPC (staph & strep), GNR +/-   NOT FOR Pseudomonas, Acinetobacter, or Serratia.   Sulbactam & Clavulanic acid – are beta-lactamase

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