Anaesthesia for patients with chronic renal failure Flashcards
Animals with chronic renal disease may have the following, which will influence
anaesthesia or the way you deal with the anaesthetic?
o Anaemia. This will alter the animals oxygen carrying capacity, the onset of
cyanosis being visible, and binding of drugs.
o Hypoalbuminaemia (if a protein losing nephropathy) will influence drug binding
o Calcium-phosphorus derangements may predispose to arrhythmias
o Chronic hypertension, may lead to cardiomegaly, ventricular hypertrophy, and
coronary arteriolar hypertrophy.
o Bleeding tendencies from bone marrow depression and poor liver function
o Nausea and vomiting from uraemia may also predispose to acid base
abnormalities
o Immunosuppression (from bone marrow suppression), so more care with
catheters.
o Altered drug behaviour (from reasons above) and also decreased renal excretion
of some drugs, especially active metabolites.
Anaesthesia and certain drugs can be detrimental to kidney function. In a renal
compromised patient, we need to minimize or prevent further damage caused. One of
the main aims of anaesthesia in renal patients is?
maintaining renal blood flow and
oxygenation of the renal tissue
The kidneys rely on certain prostaglandins such as PGI2 and PGE2 (amongst
other substances) to maintain renal blood flow in times of low blood pressure –
so avoid?
NSAIDs (which block prostaglandin production)