A. Stephen Close

PREOPERATIVE SKIN PREPARATION WITH POVIDONE-IODINE.

D URING recent years hexachIorophene-containing soaps and detergents have enjoyed widespread use as preoperative degerming agents despite the fact that such agents seIdom steriIize skin. Random cuItures of surgeons’ hands and patients’ skin in our hospita1 Ied to the conviction that a hexachIorophene soap* foIIowed by aqueous Zephiran@ chIoride (I : 1,000) often Ieft a great many viable bacteria on the skin, and that even more bacteria couId be cuItured at the concIusion of the operative procedure. For this reason interest in degerming agents which would act rapidIy to destroy most or a11 skin bacteria and maintain bactericida1 activity during surgery was stimuIated. To satisfy the psychoIogic needs of surgeons and nurses for the appearance of suds during scrubbing and to provide better mechanica cIeansing, we eIected to evaIuate Betadine SurgicaI Scrub which contains povidoneiodine and a detergent. We compared the incidence of skin reactions, wound infections and preand postscrubbing skin sterility over a period of two years, utiIizing either hexachIorophene soap or Betadine. As a resuIt of this study Betadine SurgicaI Scrub has been our principa1 operating room skin-degerming agent for nearIy four years, and this report wiI1 present our experience with this agent, particuIarIy during the two year period of study.

Postoperative adynamic ileus: An experimental evaluation of the role of d-pantothenyl alcohol

Summary 1 Following stress there may be an increased utilization of pantothenic acid in the production of acetylcholine. Relative deficiencies of pantothenic acid could result in intestinal atony under such circumstances. 2 A significant period of adynamic ileus was readily produced in dogs by a combination of exposure and manipulative trauma to the gut and peritoneum. 3 The duration of ileus produced by this method was significantly reduced in 21 dogs by the administration of d -pantothenyl alcohol. 4 These findings suggest that d -pantothenyl alcohol may prove to be of use in paralytic ileus following surgery.

Effect of intraperitoneal hyaluronidase on the reformation of intestinal adhesions

Abstract Several investigators have reported on the effectiveness of hyaluronidase in preventing formation of adhesions after the introduction of talcum powder. In this study we utilized a method for producing intestinal adhesions without the introduction of bacteria or foreign material. In this manner we were able to closely simulate clinical problems encountered in surgery today. Utilizing dogs that were known to form adhesions as a result of mechanical trauma, we found no evidence that hyaluronidase administered intraperitoneally was helpful in preventing the reformation of adhesions, even with extremely large doses. The agent was administered in four different dosage levels varying from a single application to divided doses over several days. Hyaluronidase proved to be nontoxic at all dosage levels. We wish to stress again that this method for evaluating hyaluronidase has advantages over those methods utilizing foreign material or bacteria to produce adhesions, because it is under these circumstances that the preventative agent, whenever it becomes available, will be more often used in clinical surgery.

CLINICAL EVALUATION OF D-PANTOTHENYL ALCOHOL IN PREVENTION OF POSTOPERATIVE ILEUS.

Abstract 1. 1. A double-blind clinical study of the effect of D-pantothenyl alcohol on postoperative peristalsis was conducted on two standard operative groups. 2. 2. Objective evaluation of the resumption of bowel tone was made by noting the roentgenographic bowel transit time of a lead marker which was introduced orally into the stomach immediately after surgery. 3. 3. The transit time of the markers was significantly decreased in cholecystectomy patients receiving D-pantothenyl alcohol. 4. 4. Significant improvement in bowel transit time was not seen in the gastric resection patients receiving the D-pantothenyl alcohol; however, in these patients early gastric remnant paralysis, type of anastomosis and especially vagotomy were undoubtedly strong variables affecting the end results. 5. 5. There is no justification for routine use of large doses of parenteral D-pantothenyl alcohol postoperatively. Since there is at least presumptive evidence that pantothenic acid deficiency can result from surgical stress, and since it is a harmless vitamin, one should consider its use in patients with prolonged malnutrition either before or after surgery. 6. 6. Our clinical experience tells us that there is usually a simple explanation for prolonged postoperative ileus, such as infection, dehiscence or obstruction.