Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Principles > Anesthetic Considerations for Renal Procedures > Flashcards

Anesthetic Considerations for Renal Procedures Flashcards

1
Q

What population typically has GU procedures?

A

Elderly, with coexisting medical illnesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What structure is very close to the urethral openings?

A

Obturator nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the significance of the proximity of the obturator nerve to the urethral opening?

A

Could be stimulated during a procedure causing the patient to box the surgeon in the head with their knees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

At what MAP does auto regulation of the kidneys occur?

A

75-160mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

At what MAP will filtration cease?

A

Less than 60mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can occur if there is damage to the renal arteries?

A

Massive blood loss since they branch directly off of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where are the kidneys located?

A

Retroperitoneal between T12-L4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What level block is required for somatic blockade for a renal procedure?

A

T8-L3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What sensory level blockade is required for anesthesia in a urethral procedure?

A

T10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does anesthesia affect renal function?

A

Reversible decrease in RBF, GFR urinary flow and Na excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What position is frequently used in GU procedures?

A

Lithotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are physiological consequences of the lithotomy position?

A

Decreased FRC, vital lung capacity lung volume and lung compliance
Altered venous return

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common positional injury with use of the lithotomy position?

A

Peroneal nerve injury with loss of dorsiflexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are risk factors for peroneal nerve injury?

A

Lithotomy duration greater than 4hrs
BMI less than 20
Recent smoking history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What nerve injury can occur if the legs are not moved together?

A

Sciatic stretch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does the extreme lithotomy position affect CPP?

A

Reduced CPP due to increased ICP, must have a high MAP to maintain perfusing CPP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What nerve injury is a concern in the extreme lithotomy position?

A

Brachial plexus injury from hyperabducted arms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What effects does a kidney rest have on ventilation?

A

Decreased FRC in the dependent lung
V/Q mismatch
Atelectasis in dependent lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the effect of a kidney rest on the CV system?

A

Can cause decreased venous return

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the hyper dorsal position?

A

Lateral oblique with table extended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What injuries are associated with the hyperextended dorsal position?

A

Brachial plexus injury
Peroneal and saphenous nerves
Ulnar nerve
Back strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the hyperextended position?

A

Iliac crest over break in table and table extended then table tilted head down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why does the hyperextended supine position cause facial and airway edema?

A

Causes an increase in the central venous volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Since the operative site is above the level of the heart in the hyperextended supine, what is a complication in this surgery?

A

VAE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why might a cystoscopy be performed?

A

Diagnosis of urological problems
Resection of bladder tumors
Access to urinary system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What level of regional anesthesia should be achieved with a cystoscopy?

A

T10 (umbilicus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is a major complication when a patient is in the lithotomy position for a prolonged period of time?

A

Rhabdomyolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

At what size is it acceptable to resect the prostate?

A

Less than 60g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are common causes of death in patients that have a TURP procedure?

A

MI, PE and renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why must fluid status be monitored so closely in patients having a TURP procedure?

A

Excessive absorption of irrigating fluid possible from large venous sinuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When is absorption greatest in relation to prostate resection time?

A

15-35m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the maximum amount of time the surgeon should take to resect the prostate before major bleeding issues occur?

A

Should take less than 2hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What factors influence the amount of fluid absorbed by the sinuses?

A

The flow of the fluid which is determined by the height of the bag
Surgical time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a major complication of a TURP procedure?

A

Dilutional Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Why does absorption of excessive fluid cause the dilution syndrome?

A

The solutions are non-electrolyte and hypotonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Why don’t solution used for TURP irrigation have electrolytes in them?

A

If there were electrolytes in the solution, caudry would disperse in the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

During a prostate resection, how much fluid is absorbed when the sinuses are opened?

A

20mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What two laboratory values should be assessed if dilutional syndrome is being considered?

A

Sodium (hyponatremia) and Osmolality (hypoosmolar)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What physiologic signs are seen in dilutional syndrome?

A

CHF
Pulmonary edema
HoTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How does dilutional syndrome affect RBCs?

A

Causes hemolysis administer hypotonic solution the cells swell and lysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

At what sodium level will the patient begin to show signs of confusion and restlessness?

A

120mEq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

At what sodium level will the patient begin to show signs of somnolence and nausea?

A

115mEq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

At what sodium level will the patient begin to show signs of seizures and coma?

A

110mEq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the treatment for dilutional syndrome?

A

3% saline IV no more than 100mL/hr until sodium is above 125mEq
Lasix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Why is it important to consider regional anesthesia with a TURP procedure?

A

General anesthesia can mask the symptoms associated with dilutional syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the importance of the use of glycine in the irrigation fluid for a TURP procedure?

A

Hyperglycinemia from absorption leads to neurological changes since glycine is an inhibitory neurotransmitter in the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What symptoms are associated with hyperglycinemia?

A

Nausea, malaise, vomiting, confusion, stupor, coma, blindness and siezure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the treatment for hyperglycinemia?

A

Lasix and supportive therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is another complication of a TURP procedure from excessive volume being used for irrigation?

A

Bladder perforation

50
Q

Why symptoms are felt by a sedated patient if a bladder perforation has occurred?

A

Abdominal pain
Nausea
Diaphoresis

51
Q

How can a patient develop DIC from a TURP procedure?

A

Massive blood loss, difficult to track
Resection may release fibrinolytic enzymes
Dilutional thrombocytopenia

52
Q

What reaction can be seen if the obturator nerve is stimulated?

A

External rotation and adduction of thighs

53
Q

What is the only way to stop obturator nerve response?

A

Paralysis, spinal will not block the response

54
Q

What can occur if a patient receive a TURP has a history of a spinal injury above T6-7?

A

Autonomic hyperreflexia

55
Q

What are the triggers of autonomic hyperreflexia?

A

Surgical manipulation and bladder distention

56
Q

What symptoms are seen with autonomic hyperreflexia?

A

Severe HTN, bradycardia and dysrhythmias

57
Q

What can the anesthetic provider do to prevent autonomic hyperreflexia with a TURP procedure?

A

Spinal anesthesia blocks sympathetic response

58
Q

What is the best monitor for detecting early signs of TURP syndrome or bladder perforation?

A

Mental status assessments

59
Q

What is removed with a radical retropubic prostatectomy?

A

Prostate, seminal vesicles and part of the bladder neck removed

60
Q

What is the benefit to performing a RRP?

A

Nerve sparing

61
Q

What position is the patient placed in for a RRP?

A

Hyperextended supine

62
Q

Why don’t patients typically tolerate a RRP with regional anesthesia?

A

Trendelenberg and large amounts of IV fluid may lead to upper airway edema

63
Q

What are major complications associated with RRP procedure?

A

Massive blood loss with resection of the prostate
VAE
Nerve injury from position (brachial plexus)

64
Q

Why is anesthetic management complicated in a radical perineal prostatectomy procedure?

A

Extreme lithotomy position, increase PIP and CVP make ventilation difficult

65
Q

What is a benefit to the RPP procedure?

A

The abdomen is not entered

66
Q

What is a consequence of the RPP approach?

A

Not generally nerve sparing, impotence

67
Q

What is the most common cancer of the GU tract?

A

Prostate cancer

68
Q

What habit is strongly associated with bladder cancer?

A

Cigarette smoking

69
Q

What coexisting diseases are typically present with bladder cancer?

A

COPD and CAD

70
Q

What tissues are taken out in a radical cystectomy in males?

A

Bladder, prostate, seminal vesicles and part of the urethra

71
Q

What tissues are taken out in a radical cystectomy in female?

A

Uterus, cervix, ovaries, part of the urethra and anterior vaginal vault

72
Q

What two ways can urine be diverted after a radical cystectomy?

A

Ileal conduit-urestomy bag on abdominal wall

Ileal pouch-pouch created inside abdominal wall to create a bladder

73
Q

What anesthetic gas should be avoided with a radical cystectomy?

A

N2O

74
Q

When is the peak incidence of adenocarcinoma of the kidney?

A

50-60 years old

75
Q

Where can the adenocarcinoma of the kidney extend to in 5-10% of people that have it?

A

Renal vein and IVC asa thrombus

76
Q

What are comorbidities associated with adenocarcinoma of the kidney?

A

Smoking is a risk factor

CAD & COPD

77
Q

Why is it important to know if the adenocarcinoma has spread to the IVC prior to surgery?

A

Will require bypass for graft of SVC

78
Q

What should the pneumoperitoneum be inflated to for a laparoscopic nephrectomy?

A

14-16mmHg, higher pressures can compress the vena cava

79
Q

What is the initial treatment for testicular cancer?

A

Radical orchiectomy

80
Q

If seminomas are present with testicular cancer, what is the post surgical treatment?

A

Retroperitoneal radiotherapy

81
Q

If seminomas are not present with testicular cancer, what is the post surgical treatment?

A

Retroperitoneal lymph node dissection and Chemotherapy

82
Q

What should the provider be looking for when traction is applied to the spermatic cord?

A

Reflex bradycardia

83
Q

What are common reasons for a male to have a circumcision later in life?

A

Phimosis (obstruction of urine flow)

Recurrent infection

84
Q

What procedures can be done for stress urinary incontinence?

A

Stamey Procedure
Raz bladder neck suspension
Sling procedure

85
Q

What is the number one reason for a kidney transplant?

A

Insulin dependent diabetes in caucasians

86
Q

What are the contraindications for a kidney transplant?

A

Infection and cancer

87
Q

What should a patients potassium be prior to renal transplant?

A

Should be less than 5.5mEq

88
Q

How could the provider anticipate the fluid status of a renal transplants patient?

A

Hypervolemia if done prior to dialysis

Hypovolemia if done after dialysis

89
Q

Why is it important to give patients receiving a renal transplant a preoperative antibiotic?

A

Immunocompromised due to chronic uremia

90
Q

What should be given prior to temporary clamping of the iliacs?

A

Heparin

91
Q

Why is mannitol given after renal transplant?

A

Osmotic diuresis after reperfusion

92
Q

What volatile should be avoided with renal transplants?

A

Sevoflurane –> Compound A

93
Q

What paralytics are best to use with renal transplants?

A

Cisatracurium and Atracurium (Hofman Elimination)

94
Q

What interventions can be done to maximize renal blood flow at time of graft reperfusion?

A

Blood volume expansion
Mannitol
Furosemide

95
Q

What type of intervention is necessary for large stones that will not pass beyond the renal pelvis?

A

Percutaneous Lithotripsy

96
Q

Wat position are patients placed in for a percutaneous lithotripsy?

A

Prone and the bed may be moved 180 degrees

97
Q

What is a potential injury that can occur from a percutaneous lithotripsy?

A

Kidney injury from high pressure fluid delivery for nephroscope

98
Q

What kind of technology is used to break the stone in a percutaneous lithotripsy?

A

Ultrasonic probe

99
Q

What position is the patient in for a laser lithotripsy?

A

Lithotomy

100
Q

What type of stones is a laser lithotripsy useful for?

A

Smaller stones

101
Q

What is ectracorporeal shock wave lithotripsy?

A

High energy shock waves disrupt kidney stones

102
Q

What type of stone are resistant to ESWL?

A

Calcium oxalate monohydrate
Calcium Phosphate
Cystine Calculi

103
Q

What stones is the ESWL procedure best?

A

Stones in the renal pelvis or upper two thirds of ureters

104
Q

What are common elements of all lithotriotors?

A

Ability to localize stone target
Generation of acoustical shock waves
MEchanism for focusing shock waves onto target stone
Technique for coupling shock wave generator to the patient

105
Q

What is the goal of ESWL?

A

Pulverize calculi to allow urinary excretion over following weeks

106
Q

Why is the timing of the ESWL shock wave so important?

A

Synchronized 20ms after R wave which corresponds to ventricular refractory period, prevents Vfib

107
Q

About how many shock treatments are required for ESWL?

A

1000-4000 shocks

108
Q

What are absolute contradictions to ESWL treatment?

A

Pregnancy, coagulopathy, intra-abdominal calcific process (AAA), orthopedic implants in lumbar/pelvic area

109
Q

If a patient has a SB heart rhythm why might a provider give atropine or glycopyrolate to a patient receiving ESWL?

A

To speed the HR in order expedite the process

110
Q

What are relative contraindications to ESWL?

A

Morbid obesity and pacemakers/AICDs

111
Q

What do first generation lithotripters require to function?

A

Immersion in water bath serves as acoustic coupling substance

112
Q

How does a second generation lithotripters function?

A

Membrane over shock wave generator allows patient to remain dry

113
Q

What are the benefits of a third generation lithotripter?

A

Smaller, lighter, enhanced focal point

Multifunctional devices for urinary tract and biliary tract

114
Q

If general anesthesia is used for lithotripsy how should the vent setting be adjusted?

A

Small TV to minimize stone displacement

115
Q

What type of anesthesia is preferred for immersion type lithotriptors?

A

Regional

116
Q

What level block is required for lithotripsy?

A

T4-6

117
Q

What is a major disadvantage of regional anesthesia with lithotripsy procedures?

A

Inability to control diaphragmatic movement, can displace stone in excess of 12mm

118
Q

What type of stone removal procedure has a high incidence of dysrhythmias?

A

ESWL

PAC and PVS most frequently noted

119
Q

If emersion techniques are used what precautions should be taken so that accurate VS are obtained?

A

Cover EKG pads with water proof dressing
Clip B/P cuffs
Pulse ox on ear or nose

120
Q

What is a common reason for a orchipexy in pediatric patients?

A

Undescended testicle

121
Q

What type of regional anesthesia could be used for an orchioplexy?

A

Ilioinguinal nerve block

Advanced Principles (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions