PROPHYLACTIC ANTIBIOTICS IN NASAL SURGERY - THE IMPACT OF SURGICAL TECHNIQUES ON TISSUE PENETRATION AND PHARMACOKINETICS

Prophylactic antibiotics (cefuroxime 1500 mg) were administered during induction of anesthesia to 34 patients undergoing nasal surgery. The infusion ended at the time of mucosa incision (mean infusion time: 22 min). A hemitransfixion incision was followed by elevation of the muco perichondrium on both sides of the septum. The blood supply of the car tilage was thus diminished essentially. In the septal cartilage, the c oncentration of cefuroxime 68 min after the administrations of antibio tic was 28.1 mug/g; this concentration was 19.8 mug/g in the septal bo ne at 74 min. The mean peak plasma concentration was 158 mug/ml and th e end half-life elimination time 77 min. High antibiotic concentration s in the cartilage resulted from passive diffusion through the septal mucosa and occurred at a mean time of 22 min. The time between the sta rt of infusion at the induction of anesthesia and interruption of the septal blood supply by separating of the septum from overlying soft ti ssues was sufficient for developing high antibiotic concentrations. Du ring nasal surgery the routine approach to the septum.had no influence on the efficacy of antimicrobial prophylaxis.