Brainscape's Knowledge GenomeTM

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


See full index

APA 2 > APA 2 - Anesthesia for Urologic Procedures > Flashcards

APA 2 - Anesthesia for Urologic Procedures Flashcards

1
Q

Urologic endoscopy is performed to visualize and evaluate the upper and lower urinary tracts to diagnose and treat conditions such as

A

hematuria, pyuria, calculi, trauma, cancer

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

Upper urinary tract

A

ureter and kidney

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

lower urinary tract

A

bladder, prostate, urethra

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

Nerve injuries are a concern for these types of patients because they’re in the lithotomy position. What nerves are at risk?

A

common peroneal, saphenous, sciatic, obturator, femoral

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

Compression of the fibular head on the leg brace can result in injury to what nerve?

A

common peroneal

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

Compression of the tibial condyle can result in injury to what nerve?

A

saphenous nerve

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

Excessive external rotation of legs and excessive extension of the knees can result in injury to what nerve?

A

sciatic nerve

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

Excessive flexion of the groin can result in injury to what nerves?

A

obturator and femoral

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

When lowering the legs from the lithotomy position what may happen?

A

BP fall

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

Bladder rupture/injury secondary to ADDUCTOR muscle contraction from _______ ________ stimulation from electrocautery

A

obturator nerve

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

When is there an increased risk of Obturator reflex from stimulating the obturator nerve?

A

When resecting lateral wall tumors

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

________is passage of a rigid scope through the urethra

A

cystoscopy

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

Can a cystsocopy be done with 2% lidocaine jelly?

A

apparently yes

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

Urethral stimulation, dilation and distention of bladder can be painful requiring _____ or _______ anesthesia

A

general or regional

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

If regional anesthesia is chosen for a cystoscopy, a ___ to ___ sensory level is required and ___ for ureters

A

T9-T10 / T8

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

Review dermatome man on slide

A

16

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

Cystoscopy for retrograde ureteral catheterization is used for what?

A

to visualize the ureter and kidney, to place stents, to drain obstructions, to remove renal calculi

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

TURB

A

Transurethral resection of the bladder

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

TURB is where endoscopic resection and electrodesiccation are used to treat ________ __________ tumors

A

superficial bladder

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

What kind of anesthesia for a TURB and why?

A

General anesthesia - no coughing or straining wanted b/c increases risk of bladder perforation

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

If using regional anesthesia for a TURB, the bladder becomes ________ and may become thinner when ________, increasing the risk of _______

A

atonic / distended / perforation

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

If doing a TURB on an elderly person, ________ is better than general

A

regional

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

S/S of bladder perforation in the awake patient

A

If periotneal cavity entered will have shoulder discomfort, Nausea, vomiting

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

If a high-grade malignancy present and the bladder is perforated there is a risk of what as it relates to the cancer?

A

seeding the cancer cells into the peritoneum

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

Blood loss and bacteremia can also happen from a _____ _____

A

bladder perforation

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

Lavaging the bladder can result in ________, especially if perforated

A

hypothermia

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

The awake patient will experience _______ fullness, ________ spasm and PAIN with a bladder perforation

A

suprapubic / abdominal

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

______ and _____ are early signs of bladder perforation followed by SEVERE ________

A

HTN / Tachycardia / HYPOTENSION

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

Cool irrigation causes ___________ and results in systemic cooling. ____ _______ will decrease this risk

A

vasoconstriction / warm fluids

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

______ is a risk which is triggered by release of prostatic thrombogenic substances - especially with cancer of prostate

A

DIC

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

Have to be prepared to convert to an _____ _____

A

open procedure

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

TURP

A

Transurethral resection of the prostate

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

For a TURP, ______ or ______ prostate tissue is removed by electrosurgical resection under direct endoscopic vision

A

neoplastic / obstructive

34
Q

TURP is performed by application of a high-frequency current to a wire loop. Hemostasis is achieved by sealing the vessels with the _________ current

A

coagulation

35
Q

An optically clear, nonconductive, nonhemolytic, nontoxic solution is required to _______ the bladder for a TURP

A

distend

36
Q

TURP general anesthesia considerations

A

coughing must be avoided b/c it increases the risk of bleeding

37
Q

What anesthesia is preferred for TURP

A

spinal

38
Q

What are the benefits for doing a spinal for TURPs?

A

the bladder will be atonic with a large capacity and thus glycine infusion pressure can be low, emptying less frequent which fascilitates resection. Post-op bladder spasm is prevented allowing for hemostasis. AWAKE PATIENTS MAY SUPPLY EARLY DETECTION OF COMPLICATIONS

39
Q

Complications of TURP

A

Blood loss and venous absorption of irrigation fluid

40
Q

Early signs of venous absorption

A

hypertension and tachycardia

41
Q

With venous absorption, CVP may rise as cardiac ________ occurs. The awake patient may complain of ______ or ________. Hypoxia and/or Hyponatremia causes ______ syndrome

A

decompensastion / dyspnea and nausea / TURP

42
Q

TURP syndrome is AKA

A

Water intoxication or Glycine Toxicity

43
Q

The awake patient may exhibit as a result of TURP syndrome

A

apprehension, disorientation, convulsions, coma

44
Q

Glycine disadvantages

A

Risk of blindness or post op visual impairment, less likelihood of TURP syndrome

45
Q

Sorbitol disadvantages

A

less likelilhood of TURP syndrome but can cause hyperglycemia and lactic acidosis

46
Q

Mannitol disadvantages

A

nonmetabolized, osmotic diuresis which causes hypervolemia

47
Q

Treatment for TURP syndrome

A

Ask surgeon to control bleeding and finish surgery fast, send blood sample for Sodium level (less than 120 mEq/L is serious), correct hypervolemia and hyponatremia with fluid restrictions and diuretics (furosemide 10-20 mg), correct hyponatremia with hypertonic solutions cautiously, NS or LR will postpone if sodium level is less than or equal to 125

48
Q

With an open prostate radical prostatectomy what is seen in 50% of patients

A

impotence

49
Q

Position for a suprapubic (retropubic) approach for a radical prostatectomy

A

supine, flex table , trendelenburg

50
Q

Position for a perineal approach for a radical prostatectomy

A

extreme lithotomy position

51
Q

Which approach has more hemorrhage for radical prostatectomy

A

Retropubic

52
Q

With radical prostatectomy, blood loss occurs during control of ____ _____ _____

A

dorsal venous complex (get up and look at suction)

53
Q

Radical prostatectomy can be done under regional or general anesthesia but regardless, a large _____ is a must

A

IV

54
Q

During a radical prostatectomy what diagnosistic dye can cause hypotension and drop your oxygen saturation?

A

methylene blue (can cause sat to go to 65% for 1-2 minutes)

55
Q

Indigo carmine dye has an alpha sympathomimetic effect to increase ____

A

BP

56
Q

Indications for nephrectomy

A

chronic infection, trauma, cystic or calculus disease, neoplasm

57
Q

A nephrectomy is perfromed by _____ _______ or _____ _____ incicsion

A

lateral retroperitoneal / anterior abdominal

58
Q

For nephrectomy you will be using a _____ flex table and KIDNEY BAR which may cause vena cava ______ and _______. General or combined general with regional anesthesia is used for this surgery

A

lateral / compression / hypotension

59
Q

Considerations prior to renal transplant

A

optimize prior, serum potassium should be normal, metabolic acidosis should be corrected, Anemia is common

60
Q

Renal transplant position

A

supine with roll under hip

61
Q

For renal transplant IV access should not be on the same side as the ______

A

fistula

62
Q

What muscle relaxer for renal transplant?

A

atracurium

63
Q

For a renal transplant, regional anesthesia is contraindicated by preexisiting __________ and or ___________

A

coagulopathy / immunosuppression

64
Q

You want what fluids for renal transplant?

A

NS. Avoid LR and K+

65
Q

Adequate hydration is critical for renal transplants, so cyrstalloid, colloid, and blood should be used for _____________ of the kidney

A

revascularization

66
Q

With renal transplant, ______ ______ and ________ help discourage rejection and diuresis

A

methyl prednisone / diuretics

67
Q

With renal trasnsplants, low dose _______ used if oliguric

A

dopamine

68
Q

3 major complications of kidney transplant

A

hyperkalemia, delayed renal function, graft failure

69
Q

Cold storage solutions are used to preserve kidney graft survival and minimize tissue necrosis and edema. ____ degrees celsius is goal to reduce _______ demands

A

4 / metabolic

70
Q

Continuous perfusion of the kidney causing pulsatile flow of cold perservation is pumped at ___ to __ mmHg.

A

40 to 60

71
Q

What is in the solution for cold preservation of kidney?

A

glucose, potassium, magnesium, ABX, HC03, and heparin (which can trigger hypersensitivity reaction in recipient)

72
Q

POPS

A

Portable Organ Preservation System (has changed time frame from 48 hrs to 72 hrs)

73
Q

Anesthetic considerations for Radical Cystectomy

A

Done in supine position, general or combined anesthesia, arterial and CVP, Large IV, Fluid shifting can be extensie and unable to monitor urine so need the CVP, diuretics may be needed to stimulate output, indigo carmine or methylene blue used at times

74
Q

Complications of Radical cystectomy

A

hypothermia, inadequate fluid replacement, need for post-op ventilation

75
Q

What sensory level block needed for orchiectomy and urogenital plastics procedures?

A

T9

76
Q

A/V shunts and fistulas are placed for dialysis access. Patient lies in ______ postion with arms ________. General, regional and local infiltration are all acceptable. Can do these as MAC as well. Their blood pressure are very _______.

A

supine / extended / labile

77
Q

ESWL

A

Extracoroporal Shock Wave Lithotripsy

78
Q

ESWL breaks ________ urinary tract stones with external shock waves. Cushion the interface with skin or patient is submerged in a tank of water.

A

upper

79
Q

With ESWL, the shock delivered is triggered by the _____

A

QRS

80
Q

With ESWL, there will be stents placed as well usually so the patient will need to be in the _______ position for that.

A

lithotomy

81
Q

After ESWL, adequate _______ and __________ help pass stone fragments

A

hydration / diuretics

APA 2 (7 decks)

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