Preoperative Intravenous Antibiotics Improve Surgical Safety Most Significantly
In this 35-year-old woman with acute appendicitis, fever, and stable asthma scheduled for laparoscopic appendectomy, administering preoperative intravenous antibiotics 0-60 minutes before surgical incision is the single most critical safety measure among the options provided. 1, 2, 3
Why Preoperative Antibiotics Are Essential
Broad-spectrum intravenous antibiotics must be administered within 60 minutes before skin incision to reduce surgical site infections, which affect up to 35% of emergency abdominal surgery patients. 1
The presence of fever (>38°C) in this patient indicates systemic inflammatory response and likely complicated appendicitis, making antibiotic prophylaxis even more critical for preventing postoperative infectious complications. 1
A single preoperative dose of cefazolin 1-2 grams IV (or equivalent broad-spectrum coverage) should be given 30-60 minutes before incision, with agents like fluoroquinolones or vancomycin requiring 120 minutes if used. 1, 3
Why the Other Options Are Inadequate or Dangerous
Site Marking (Option A)
While site marking prevents wrong-site surgery and is part of the Universal Protocol, appendectomy does not require site marking as there is no laterality or multiple potential operative sites involved. 4, 5
Site marking is critical for procedures involving laterality (hernias, limbs, breasts) or specific vertebral levels, but appendectomy has a single, non-ambiguous anatomic target. 4, 6
Equipment preparation is standard operating procedure and does not represent a specific safety intervention unique to this clinical scenario. 1
Ignoring Asthma History (Option C)
This is categorically dangerous and violates fundamental perioperative assessment principles. 1
Even stable asthma requires anesthesia team awareness for appropriate medication management, avoidance of bronchospasm triggers, and preparation for potential intraoperative bronchospasm. 1
The anesthesia team must know about asthma to select appropriate agents and have bronchodilators immediately available. 1
Omitting Consent (Option D)
Informed consent is legally and ethically mandatory for all surgical procedures regardless of complexity. 1
Appendectomy carries risks including bleeding, infection, injury to surrounding structures, conversion to open surgery, and anesthetic complications that must be disclosed. 1
No surgical procedure is exempt from informed consent requirements. 1
Complete Preoperative Safety Checklist for This Patient
Antibiotic administration:
Asthma management:
- Document asthma history and current control status for anesthesia team. 1
- Ensure bronchodilators are immediately available in the operating room. 1
Surgical approach:
- Plan laparoscopic appendectomy as the preferred approach, offering less pain, lower surgical site infection rates, and faster recovery compared to open surgery. 1, 2
Timing:
- Perform surgery within 24 hours of admission to minimize complications, though the presence of fever may indicate complicated appendicitis requiring more urgent intervention within 8 hours. 1, 2
Common Pitfalls to Avoid
Do not delay surgery to obtain additional imaging or testing once the diagnosis is established and antibiotics are administered. 1, 2
Do not withhold antibiotics while waiting for culture results—empiric broad-spectrum coverage must begin immediately. 1
Do not assume "stable" asthma requires no perioperative consideration—communicate this history to anesthesia. 1
For febrile patients with appendicitis, anticipate complicated appendicitis (perforation, abscess, or peritonitis) and plan for potential conversion to open surgery or extended antibiotic therapy postoperatively. 1, 2