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N934 Adv Principles Fa 21 > Brain Death and Anesthesia > Flashcards

Brain Death and Anesthesia Flashcards

1
Q

UNOS and its responsibilities/role

A

united network for organ sharing
have to be a member of this organization to do anything or get reimbursement
develops policy, monitors/enforce processes of OPTN (organ procurement and transplantation network), maintain OPTN membership and review applications

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2
Q

allograft/homograft

A

tissue for transplant derived from a non twin donor of the same species. human to human like kidney donation

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3
Q

autograft

A

tissue forr transplant derived from the recipient ex)burn patient donating own skin

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4
Q

orthotopic

A

implanting organ in anatomic position after native organ is removed

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5
Q

heterotopic

A

implanting an organ leaving the native organ in place (like kidneys)

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6
Q

xenograft/heterograft

A

tissue grafted from one species to another ex) pig valves, ex)baboon heart transplanted into child (who is v dead)

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7
Q

Major histocompatibility complex (MHC) antigens

A

cell surface glycoproteins that establish immunologic identity.

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8
Q

MHC antigens classes

A 
class 1: human leukocyte antigen (HLA) a-b-c (classic transplant antigens)
class 2: HLA DR-DQ-DP (on activated T cells)
increase in class II HLA usually increases PRA and makes matching more difficult
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9
Q

major blood group antigens

A

ABO potent transplant antigens. usually tested for kidney, pancreas, and lungs but sometimes have to test post lung transplant

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10
Q

describe varying degrees of HLA tissue typing

A

kidney: ABO and HLA matching, t cell cost match and PRA (panel reactive antibody profile)
heart, liver- ABO and other factors such as size/urgency

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11
Q

types of organ donors

A

cadaveric (deceased): donation after brain death (DBD)
non heart beating organ donor; donation after cardiac death (DCD)
living donor: kidney paired donation

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12
Q

deceased organ donors: 4 criteria to meet and something to consider

A

crate: previously healthy, brain death established, negative for extra cranial malignancy, absence of untreatable infection. consider donor mechanism of injury (usually violent)

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13
Q

definition of brain death

A

irreversible cessation of all functions of the brain including the brainstem.

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14
Q

for determination of brain death, you have to rule out these reasons for reversible cerebral dysfunction

A 
hypothermia
hypotension
metabolic/endocrine instability
drug overdose
(look at chart in miller)
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15
Q

when doing determination of brain death examination, explain the criteria

A 
comatose (unresponsive to verbal stimuli)
absence of cerebral cortical function (non responsive to painful stimulus. absence of spontaneous movement)
loss of brain stem function (absence of reflexes)
supporting studies (EEG, cerebral blood flow studies)
neurological absence of brainstem function
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16
Q

when doing determination of brain death examination, describe how to assess for neurological absence of brain stem function

A

pupillary response to light
corneal reflex
oculocephalic reflex absent (dolls eye response)
oculovestibular reflex absent (cold caloric test)
gag and cough reglex
absent respiratory reflex (apnea test)

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17
Q

determination of brain death: how to perform the apnea test

A

100% FiO2 for 10 minutes
normalized PaCO2 (confirmed by ABG, T piece for 7-10 minutes, repeat ABG)
PaCO2 >60mmHg during test
absence spontaneous ventilation

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18
Q

who cannot declare brain death

A

transplant team

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19
Q

DCD s/p cardiac arrest: death anticipated within

A

1-2 hours after life support is withdrawn

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20
Q

warm ischemia time can be _______ v _________

A

controlled (ICU, decision to take off life support) versus uncontrolled

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21
Q

living organ donors: kidney and advantages

A

decreased cole ischemic time

less time on waiting list

22
Q

kidney living organ donors: how is the surgery performed

A

laparoscopic or open

23
Q

kidney living organ donors: selection of kidney from living donor

A

usually left side because it is easily accessible and longer vasculature

24
Q

kidney living organ donors: anesthetic

A

GETT standard monitors, maintain UOP (mannitol, lasix 30m prior to removal), 10-20ml/kg/h NS

25
Q

kidney living organ donors heparin

A

about 5000 units prior to clamping of renal artery. have protamine on hand but won’t probably use because apparently 5000u isn’t a big dose

26
Q

living organ donors: partial liver for adults

A

sections 5,6,7,8 taken for adults and donor is left 1/3 of their liver. right side

27
Q

living organ donors: partial liver for pedes

A

left side taken from donor, smaller, easier to retrieve

28
Q

living donor: partial liver anesthetic technique and monitoring

A

monitoring (CVP, 2 PIV’s, art line)
+/- epidural (coags? taking out the liver rn..)
NGT
no N2O (bowel distention would make visualization difficult)

29
Q

living donor: partial liver volume considerations

A

can either drop CVP with transaction (<5mmHg to minimize blood loss), can volume load before cross clamp, isovolumic hemodilution or cell saver can be possible. if not using hemodilution, limit fluids to not engorge liver

30
Q

what is cross clamped in a liver transplant on a living donor

A

hepatic pedicle

31
Q

organ preservation strategies

A

hypothermia (decrease metabolism)

preservative solutions

32
Q

what is the benefit of preservative solutions for organ preservation strategies

A

maintains cellular integrity
prevent cellular swelling, vasospasm and build up of toxic metabolites
provides source of energy

33
Q

organ preservation ex vivo

A

rapid cooling at 4 degrees celsius

preservative solution

34
Q

what preservative solutions are utilized for intraabdominal orrgans versus heart

A

UW used for intraabdominal organs (has alot of K)

celsior/cardioplegia: heart

35
Q

organs removed in this order in relation to its susceptibility of ischemia

A

heart, lung, liver, kidney

36
Q

maximum organ preservation times: heart and lung

A

4-6h

37
Q

maximum organ preservation times: liver

A

8-12h up to 24h (but 24h not popular)

38
Q

maximum organ preservation times: pancreas

A

12-18 hours

39
Q

maximum organ preservation times: kidney

A

24-36 hours

40
Q

presentation of brain death donor in OR

A

hypotension (related to loss of vasomotor control)
decreased CO and SVR
decreased oxygenation (aspiration, atelectasis, pulmonary edema)
DI (destruction of HPA)
bradycardia (b/c loss of vagal motor nucleus, increased ICP)
still have visceral and somatic reflexes. will have reflex pressor response (pain.muscle twitching) and spinal somatic reflexes.
for this reason, give muscle relaxants, opioids, and volatile still

41
Q

colloid or crystalloid for lung and pancreas?

A

colloid preferred

42
Q

goals for preservation of organ function include

A 
MAP 60-100
UOP .5-3ml/kg/hr
HGB >10gm/dL
glucose 120-180mg/dL
CVP 5-10mmHg
FiO2 <40% if tolerated to minimize effects of O2 toxicity if lung retrieval involved
PEEP no more than 10cm H2O
Vt 6-8
SaO2 >95%
PaO2 >100mmHg
core temp >35c
43
Q

which pressors to consider during organ donation

A

1st line: dopamine

2nd line: vasopressin

44
Q

how to treat bradycardia for a brain dead patient

A

resistant to atropine since there is no vasomotor control so you have to use direct acting agents
so use isoproterenol

45
Q

how to treat DI for brain dead patient

including type of IVF

A

vasopressin or DDAVP

free water D5W .45%NS, fluid type based on hourly serum electrolytes. check every hour

46
Q

donor anesthesia and methylprednisolone

A

can protect heart, kidneys, lungs from ischemic injury

47
Q

donor anesthesia and PGE1

A

lung protection/retrieval ->membrane stabilization

48
Q

donor anesthesia overview of care

A 
standard monitors, aline, CVP, swan
pressors and NG/BB
PRBC's/FFP for HGB
heparin
mannitol/lasix 
long acting NDMR
49
Q

donor anesthesia special considerations

A 
confirm ETT placement with surgical team
midline incision, neck to pubis 
sternal saw-drop lungs
organs mobilized and dissected
aorta cross clamped and ventilator turned off (and you can leave)
50
Q

donor anesthesia special considerations heart lung procurement

A

continue to ventilate manually about 4 breaths per minute, not for abdominal organs

N934 Adv Principles Fa 21 (23 decks)

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