Brainscape's Knowledge GenomeTM

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


See full index

931: Advanced Principles of Anesthesia I > Anesthetic considerations for urologic surgery > Flashcards

Anesthetic considerations for urologic surgery Flashcards

1
Q

How much cardiac output does the kidney receive?

A

20-25%

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

The nephron is made up of

A

outer cortex & inner medulla

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

Homeostasis is maintained in the kidney through

A

filtration
reabsorption &
tubular excretion

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

Normal GFR is

A

125 mL/min

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

Up to ____ of the filtrate is reabsorbed

A

99%

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

Things that should not be seen in the urine include

A

glucose, protein, bilirubin

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

The renal vasculature is innervated by

A

SNS

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

Renal hormones include

A

aldosterone, antidiuretic hormone, angiotensin, atrial naturetic factor, vitamin D, prostaglandins

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

Catecholamines result in a

A

decrease in urine output

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

Anesthetic drugs affect the kidneys by

A

depress normal renal function
impairment of autoregulation
renal blood flow may decrease by 30-40%

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

General anesthesia is associated with a decrease in

A 
renal blood flow
GFR
urinary flow
electrolyte secretion 
-similar changes occur after spinal & epidural anesthesia- magnitude of change parallels degree of sympathetic block & BP depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

All ______ cause mild increase in renal vascular resistance

A

volatile anesthetics

-compensatory mechanism in response to decreases in CO & SVR

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

Historically________ caused high fluoride ion concentrations & _________ characterized by polyuria

A

methoxyflurane; nephrotoxicity

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

These factors attenuate reductions in renal blood flow & GFR

A

preoperative hydration, decreased concentrations of volatile anesthetics, & maintenance of blood pressure

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

Sevoflurane has not

A

been associated with nephrotoxicity even though it has been associated with high fluoride levels

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

Sevoflurane produces

A

Compound A which can potentially cause nephrotoxicity

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

In an effort to decrease risk of compound A with sevoflurane,

A

use high gas flows (1L/min FGF for 2 MAC-hours max)
decrease gas concentration
use of carbon dioxide absorbents

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

Isoflurane & desflurane are

A

not associated with nephrotoxicity

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

Signs and symptoms of fluoride nephrotoxicity include

A 
polyuria
hypernatremia
serum hyperosmolality
elevated BUN & creatinine
decreased creatinine clearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Nephrotoxicity with volatile anesthetics is related to

A

dosage, duration, & peak fluoride concentrations

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

Fluoride ion toxicity

A

fluoride interferes with active transport of sodium & chloride in the loop of Henle
POTENT VASOCONSTRICTOR
potent inhibitor of many enzyme systems (ADH

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

Nephrotoxicity results in

A

proximal tubular swelling & necrosis

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

An acute kidney injury is defined as

A

a renal functional or structural abnormality that occurs within 48 hours- increase in creatinine 0.3 mg/dL or 50% increase; UO <0.5 mL/kg/hr x 6 hours

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

Risk for acute kidney injury is increased by

A

hypovolemia, electrolyte imbalance, & contrast dye

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

Types of AKI include

A

prerenal, intrinsic, & post renal

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

Describe the cause of prerenal AKI

A

hypoperfusion of the kidneys without parenchymal damage

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

Describe the cause of intrinsic AKI

A

result of damage to renal tissue

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

Describe the cause of postrenal AKI

A

due to urinary tract obstruction

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

Provide examples of prerenal AKI

A

hemorrhage, vomiting, diarrhea, diuretics, sepsis, shock, CHF, norepinephrine, NSAIDs, ACE-I

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

Provide examples of intrinsic AKI

A

tubular injury due to hypoperfusion, myoglobin, chemotherapy, infections, lymphoma, toxemia of pregnancy, vasculitis

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

Provide examples of postrenal AKI

A

renal calculi, peritoneal mass, prostrate/bladder urethra tumor, fibrosis, hematoma, & strictures

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

Risk factors for AKI include

A

aging- >50 years of age, preoperative renal dysfunction
comorbidities- cardiac failure & hepatic failure
surgical procedures- cardiac bypass, aortic cross-clamp, arteriograpy, intra-aortic balloon pump
emergency or high risk procedures- ruptured AAA, ischemic time, large volume of blood transfusion

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

Describe how to mitigate risks of AKI

A

hydration, limit contrast dye, diuretics

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

Anuric is defined as

A

UO <100 mL/day

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

Polyuric is defined as

A

UO >2.5L/day

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

Oliguric is defined as

A

UO <400 mL/day

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

AKI preoperative treatment includes

A

fluid deficits- BALANCED SALT SOLUTION ( NS) to minimize ADH & RAAS release
attenuation of surgical stress
patient monitoring considerations- arterial line, transesophageal echocardiogram, CVP, foley catheter

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

Fluid replacement for perioperative AKI treatment includes

A

500-1L bolus for hourly UO below acceptable levels
colloids may not be superior to crystalloids
high risk patients 0.5-1.0 mL/kg/hr

39
Q

AKI perioperative treatment includes

A

fluid replacement
improve cardiac output
normalize SVR
diuretic use to prevent oliguria is not recommended

40
Q

Early treatment of prerenal causes has

A

best outcomes

41
Q

Postrenal has good prognosis with

A

early identification

42
Q

The most difficult AKI type to treat is

A

intrarenal

43
Q

Most common cause of AKI is

A

prolonged hypoperfusion

44
Q

_______ reduces mortality in AKI more than dialysis

A

prophylaxis

45
Q

Duration & magnitude of initial insult determine

A

severity of AKI

46
Q

Key strategy for perioperative management of AKI is to

A

limit magnitude & duration of renal ischemia

47
Q

Treatment for AKI inclues

A

administering volume (NS) to euvolemia
improving CO by afterload reduction
normalizing SVR

48
Q

Renal function decreases

A

10% per decade

49
Q

CKD is present when

A

GFR is less than 60 mL/min/1.73 m2 for three months

50
Q

Signs & abnormal labs do not appear until

A

less than 40% of normal functioning of nephrons remain

51
Q

When 95% loss of renal function occurs, symptoms include

A

uremia, volume overload, CHF

52
Q

The respiratory effects of CKD includes

A

respiratory depression secondary to delayed clearance

53
Q

The neurologic effects of CKD include

A

fatigue & weakness are early complaints
autonomic neuropathy–> b/c electrolytes mess w/ nerve functioning–> causes airway & aspiration risk
disequilibrium syndrome- severe neurologic effects

54
Q

The cardiovascular effects of CKD include

A

hypertension & CHF- 90%volume dependent; 10% secondary to increased renin; pericardial effusion
pericarditis seen in patients with severe anemia
ischemic heart disease is most common cause of death- outcomes better in CABG with angioplasty

55
Q

Gastrointestinal effects of CKD include

A

dialysis patients are at greater risk for GI bleeding

56
Q

Hematologic effects of CKD include

A

normochromic, normocytic anemia- decrease in erythropoietin production, reduction in erythrocyte life secondary to dialysis, blood loss from frequent sampling
prolonged bleeding- decrease in platelet function, dialysis within 24 hours will correct, desmopressin increases levels of Factor VIII

57
Q

Infectious effects of CKD include

A

protein malnutrition

neutrophil, monocyte, & macrophage changes

58
Q

Endocrine effects of CKD include

A

hyperparathyroidism

adrenal insufficiency

59
Q

The leading cause of death in dialysis patients is

A

infection

60
Q

Describe electrolyte effects of CKD

A

sodium wasting
hypocalcemia
hyperkalemia

61
Q

Hyperkalemia is a

A

serious disturbance in patients with renal disease

-fatal dysrhythmias or cardiac standstill can occur when K+ levels reach 7-8 mEq/L

62
Q

Treatment of hyperkalemia includes

A 
25-50 g dextrose
10-20 unites of insulin
50-100 mEq of sodium bicarb 
calcium chloride
albuterol
63
Q

Preoperative lab levels of potassium should be

A

checked even if dialysis is performed within 6-8 hours of surgery

64
Q

Physiologic effects of dialysis include:

A

hypotension, muscle cramping, anemia, & nutritional depletion

65
Q

EKG changes for the patient with hyperkalemia include

A

peaked T waves
progresses to widen QRS, peaked T waves
sinusoidal waves next- very bad

66
Q

Preoperative anesthetic considerations for the CKD patient includes

A

pertinent lab & diagnostic tests

continue antihypertensive medications

67
Q

Intraoperative anesthetic considerations for the CKD patient includes

A

monitoring, regional anesthesia, general anesthesia, fluid management

68
Q

Postoperative anesthetic considerations for the CKD patient includes

A

dialysis within 24 hours

69
Q

In anuric patients, it is contraindicated to give

A

potassium containing solutions (LR)

70
Q

Blood products are reserved for

A

patients who need increased oxygen-carrying capacity

71
Q

Fluid management for the prevention of AKI includes

A

UO 0.5-1.0 mL/kg/hr recommended

mildly compromised function- balanced salt solution at 3-5 mL/kg/hr. with 500 mL bolus as needed

72
Q

Intraoperative monitoring is based on

A

patient’s physiologic status & surgical procedure & includes ECG, pulse oximetry, arterial catheter, & echo

73
Q

Pharmacologic considerations for the patient on dialysis include

A

morphine is not removed by dialysis
meperidine cannot be removed by dialysis
H2 blockers are highly dependent on renal excretion
hydromorphone has active metabolite that can accumulate

74
Q

Describe fluid management for the dialysis patient

A

insensible losses- replace with 5-10 mL/kg of D5W

if urine is produced- replace with 0.45% saline

75
Q

Fluid management for the renal insufficiency/ESRD patient icnldues

A

replace volume deficit preoperatively
intraoperative losses greater than 15% should be replaced with colloid 1:1
crystalloid without potassium at 2-3 mL/kg/hr

76
Q

The most reliable test for renal function is

A

creatinine clearance

77
Q

Normal creatinine clearance is

A

95-150 mL/min.

78
Q

Creatinine clearance measures

A

glomerular ability to excrete creatinine in urine
mild dysfunction 50-80 mL/min.
moderate dysfunction <25 mL/min
<10 mL/min requires dialysis

79
Q

Blood urea nitrogen is

A

10-20 mg/dL

BUN: creatinine ratio is 10:1

80
Q

Serum creatinine normal is

A

0.7-1.5 mg/Dl

for every 50% reduction in GFR, serum creatinine doubles

81
Q

Regional anesthesia for patients with kidney disease is

A

generally well tolerated

82
Q

Major concerns for regional anesthesia for the patient with kidney disease include

A

intolerance, coagulopathy, peripheral neuropathy, risk of infection

83
Q

Block duration is _____ by renal failure

A

not affected

84
Q

Spinal & epidural considerations for the patient with renal failure includes

A

platelet count, PT/PTT, ASRA coags

85
Q

In general anesthesia for the renal failure patient, IV drugs are affected by

A

volume of distribution is increased
decreased protein binding
low pH
renal excretion

86
Q

Describe the effects of renal failure on ketamine, benzodiazepines, propofol, dexmedetomidine, & remifentanil.

A

ketamine & benzodiazepines are less protein bound
propofol appears to be safe
dexmedetomidine cleared by liver
remifentanil- reduced clearance in patients with ESRD
fentanyl has prolonged half-life

87
Q

Patients with ESRD generally require dialysis

A

24-36 hours after major surgery

88
Q

Uremic patients may require fluid replacement with

A

red blood cells
FFP
colloid solutions

89
Q

In patients with renal insufficiency, give

A

preoperative volume replacement

90
Q

Describe the use of succinylcholine in renal failure patients.

A

increases serum potassium 0.5 mEq/L
succinylmonocholine (precursor to products of metabolism)
cholinesterase deficiency in uremic patients

91
Q

Describe the use of pancuronium in renal failure.

A

80% excreted in urine

92
Q

Describe the use of atricurium, cisatricurium, and mivacurium in renal failure patients.

A

duration not increased in renal failure

slower onset with cisatricurium and mivacurium

93
Q

Describe the use of vecuronium in renal failure patients.

A

approximately 30% excreted via renal system

effects rapidly reversed with dialysis

94
Q

Describe the use of rocuronium in renal failure patients

A

renal failure reduces clearance by almost 40%

& has longer DOA

931: Advanced Principles of Anesthesia I (22 decks)

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