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796 Anaesthesia

An in-hospital workup of a 78-year-old hypeensive, mildly asthmatic man who is receiving chemotherapy for colon cancer reveals symptomatic gallstones. Preoperative laboratory results are notable for a hematocrit of 24% and urinalysis with 18 to 25 WBCs and gram-negative bacteria. On call to the operating room, the patient receives intravenous penicillin. His abdomen is shaved in the operating room. An open cholecystectomy is performed and, despite a lack of indications, the common bile duct is explored. The wound is closed primarily with a Penrose drain exiting a separate stab wound. On postoperative day 3, the patient develops a wound infection. Which of the following changes in the care of this patient could have decreased the chance of a postoperative wound infection?

AIncreasing the length of the preoperative hospital stay to prophylactically treat the asthma with steroids
BTreating the urinary infection prior to surgery
CShaving the abdomen the night prior to surgery
DContinuing the prophylactic antibiotics for 3 postoperative days
Anaesthesia
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798 Anaesthesia

A 71-year-old man develops dysphagia for both solids and liquids and weight loss of 60 lb over the past 6 months. He undergoes endoscopy, demonstrating a distal esophageal lesion, and biopsies are consistent with squamous cell carcinoma. He is scheduled for neoadjuvant chemoradiation followed by an esophagectomy. Preoperatively he is staed on total parenteral nutrition, given his severe malnutrition reflected by an albumin of less than 1. Which of the following is most likely to be a concern initially in staing total parenteral nutrition in this patient?

AHyperkalemia
BHypermagnesemia
CHypoglycemia
DHypophosphatemia
Anaesthesia
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