Facial Excisional Biopsy

• Dr. Brown:
  • Gown – XL, XL Length
  • Gloves – 8 Indicator glove, 7.5 Nonlatex gloves
• Dr. Chandler:
  • Gown – L
  • Gloves – 5.5, 6.0 if 5.5 unavailable
• Sean Kirby PA-C:
  • Gown – XL
  • Gloves – 7.5 Indicator Glove, 7 Nonlatex glove

• Pre-operative Medications
  • Night before:
    • Scopolamine patch placed behind ear
    • Shower with Hibiclens for couple days before surgery 4% topical chlorhexidine soap.
  • In pre-op holding ~1 hour before surgery:
    • Tylenol 975mg PO x1
    • Gabapentin 600mg PO x1
    • Celebrex 400mg PO x1

• Intra-operative Medications
  • Ancef 2 grams IV (ok if allergic to Penicillins).   Vancomycin 1g IV (if allergic to Ancef).
  • Infiltration Solution (PHARMACY TO PREPARE, IN PRE-OP ORDERS)
    • NS or LR 500 mL
    • Ropivicaine (Naropin) 300mg
    • Clonidine 0.3mg
    • Dexamethasone 4mg

• Post-operative Medications (Prescribed pre-op)
  • Tylenol 650mg PO q6 hours scheduled
  • Methocarbamol 1500mg PO q6 hours scheduled
  • Gabapentin 300mg PO PO q6 hours scheduled  (if not too expensive)
  • Cephalexin 500mg PO q6 hours scheduled for 4 doses starting after surgery
  • Celebrex 200mg PO BID scheduled (if not too expensive)
  • Pericolace 1 tab PO BID scheduled
  • Phenergan 25mg PO q8 hours PRN nausea
  • Oxycodone 5mg tabs, 1-3 tabs PO q4 hours PRN pain
  • Ibuprofen 600mg PO q6 hours scheduled, starting 48 hours after surgery
  • Refresh tears
  • Refresh PM ointment

• Anesthesia
  • Anesthesia choice

• Patient Position
  • Supine, turn bed 90 degrees

• Bed Attachments
  • Arm boards, Ulnar nerve pads, Kerlex OR Tuck Arms

• Patient Warming
  • Blanketrol, Arctic Sun, or underbody warmer
  • IV fluid warmer

• DVT Prophylaxis
  • Bilateral SCDs in OR. ON and working BEFORE induction of anesthesia.

• Foley Catheter
  • No

• Instrument Sets
  • Face

• Surgical Packs
  • Face

• Surgical Prep
  • 5% Betadine for face

• Irrigation Solutions
  • Warmed Normal Saline
  • Sterile water in basin for washing instruments
  • Standard irrigation solution (PHARMACY TO PREPARE, IN PRE-OP ORDER SET)
    • NS 1L
    • Ancef 2g
    • Gentamicin 160mg
    • Betadine Paint (10% Povidone-Iodine) 100mL

• Blades
  • 11 x 2
  • 10 x 2

• Bovie
  • Colorado tip
  • 20/20 pure and fulgurate

• Suture Available
  • 4-0 Monocryl Large cutting x2
  • 5-0 Monocryl Large Cutting x2
  • 5-0 Fast Gut Large cutting x2
  • 6-0 Fast Gut Large cutting x2
  • 5-0 Nylon Large Cutting x2
  • 6-0 Nylon Large Cutting x2

• Drains
  • None

• Additional Supplies
  • Marking pen x 4
  • Paper Ruler

• Dressing
  • Bacitractin
  • BSS eye irrigation or any Eye saline solution
  • Refresh PM eye ointment or Erythromycin ophthalmic
  • Xeroform
  • Kerlex or 1 inch Cling wrap
  • 4″ Coban  x2