Surgical irrigation solutions

Liquids are best for decontaminating large or irregular surface areas. Hypochlorite solutions are well suited for MTFs with adequate water supplies. For hypochlorite to be most effective, it has to be relatively fresh (made daily or more frequently, particularly in a warm environment where evaporation will occur) and have a concentration of 0.5% at an alkaline pH (pH 10-11). Hypochlorite solutions are for use on skin and soft-tissue wounds only. Hypochlorite should not be used in abdominal wounds, in open chest wounds, on nervous tissue, or in the eye. Surgical irrigation solutions should be used in liberal amounts in the abdomen and chest. All such solutions should be removed by suction instead of sponging and wiping. Only copious amounts of water, normal saline, or eye solutions are recommended for the eye. Contaminated wounds are discussed later in this chapter. 

Balanced salt intraocular irrigating solution For intraocular irrigating during intraocular surgical... 

These cases of chondrolysis did not result from accidental use of relatively concentrated solutions of chlorhexidine, but from the use of a very low concentration, 0.02%, which is widely used as an irrigation solution during surgical procedures. Chlorhexidine has a damaging effect on the articular cartilage of the knee, and should not be used, even in low concentrations, to irrigate exposed articular cartilage. 

Both vasoconstrictors and vasodilators have been used in the treatment of priapism. Vasoconstrictors are thought to work by forcing blood out of the cavernosum and into the venous return. Aspiration of the penile blood followed by intracavenous irrigation with epinephrine (1 1,000,000 solution) has been effective with minimal complications.37 In severe cases, surgical intervention to place penile shunts has been used, but there is a high failure rate, and the risk of complications, from skin sloughing to fistulas, limits its use. 

Solution, for Slush A solution for the preparation of an iced saline slush, which is administered by irrigation and used to induce regional hypothermia (in conditions such as certain open heart and kidney surgical procedures) by its direct application. 

In three hospitals, 378 patients with hydatid cysts were treated surgically, including irrigation with cetrimide solutions in concentrations between 0.05 and 1% (1). No adverse effects were observed. 

For skin disinfection, chlorhexidine has been formulated as a 0.5% w/v solution in 70% v/v ethanol and, in conjunction with detergents, as a 4% w/v surgical scrub. Chlorhexidine salts may also be used in topical antiseptic creams, mouthwashes, dental gels, and in urology for catheter sterilization and bladder irrigation. 

Dilute hypochlorite solution (0.5%) may be instilled into deep, noncavity wounds following the removal of contaminated cloth. This solution should be removed by suction to a disposal container. Within a short time (ie, 5 min), this contaminated solution will be neutralized and rendered nonhaz-ardous. Subsequent irrigation with saline or other surgical solutions should be performed. 

E. Whole-bowel irrigation. Whole-bowel irrigation has become an accepted method for elimination of some dmgs and poisons from the gut. The technique makes use of a surgical bowel-clean sing solution containing a nonabsorbable... 

Edelhauser HE, Hanneken AM, Pederson HJ, van Horn DL. Osmotic tolerance of rabbit and human corneal endothelium. Arch Ophthalmol 1981 99 1281 -1287 Edelhauser HF, MacRae SM. Irrigating and viscous solutions. In Sears M, Tarkkanen A (eds) Surgical Pharmacology of the Eye. New York, Raven Press, 1985 Ehrich W. Vorderkammertest von Kunststoffen fiir Kontaktlinsen und Intraokluarlinsen. Contactolo-gica 1987 4 1-2... 

Irrigations to rinse a surgical area or a deep wound should be iso-osmotic. For disinfection or cleansing of superficial wounds this is not strictly necessary. Historically, a sterile hyperosmotic solution (NaCl 3 %, for example) is prepared for rinsing superficial moist wounds and bedsores. Hypertonicity is in fact the mechanism of action the solution has a desiccating effect. For irrigations for the bladder iso-osmosis is less important. Hypo-osmosis is more problematic than hyper-osmosis, because the osmotic value of urine is twice to trice the osmotic value of blood [4]. 

Skin A chemical bum was reported in a case of a 35-year-old man who xmderwent anterior cruciate ligament reconstruction of the left knee. A 5% aqueous solution of povidone-iodine was used as topical antiseptic and the partial thickness bum occurred xmdemeath the area of tourniquet application [77 ]. A case of massive adverse reaction (severe oedema and diffuse skin lesions) to the irrigation of surgical woxmd dehiscence with 10% povidone-iodine solution after deep-impacted, lower third molar extract was reported. The reaction was probably related to a peripheral chemical insult of mandible nerve [78 ]. 

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