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AAN2 > Class 4 Transplant > Flashcards

Class 4 Transplant Flashcards

1
Q

What is needed to show loss of cerebral cortical function?

A
  • No spontaneous movement

- Unresponsive to external stimuli

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2
Q

What is needed to show loss of brainstem function?

A
  • Apnea

- No cranial nerve reflexes

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3
Q

What are some supporting studies to help determine brain death?

A
  • Electroencephalogram

- Cerebral blood flow studies

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4
Q

What are common physiologic changes associated with brain death?

A
  • Hypotension
  • Hypoxemia
  • Hypothermia
  • Cardiac dysrhythmias
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5
Q

When is anesthesia required organ donation?

A

-Brain death (not cardiac death)

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6
Q

During recovery of vital organs for transplant, when is anesthesia support stopped? What is the one exception.

A
  • After aortic cross clamp.

- Lungs

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7
Q

What are the vital minimums needed during organ recovery?

A
  • BP >100 systolic
  • CVP 8-12
  • O2 >96
  • UO 100ml/hr
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8
Q

To be a living organ donor you must be free of what health problems?

A

-HTN, DM, CA, Kidney disease, heart disease.

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9
Q

What are the contraindications to organ implantation?

A
  • Active infection
  • AIDS
  • Poor immune system
  • Cardiopulmonary problems
  • ETOH/Drug abuse
  • extrahepatic malignancy
  • inability to comply
  • Lack of support
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10
Q

What has lead to the increase in organ transplant success?

A
  • Immunosepressive regimens

- Improved tissue typing

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11
Q

What are the major indication for kidney transplantation?

A
  • DM***
  • HTN*** induced nephropathy
  • Glomerulonephritis
  • Polycystic kidney disease
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12
Q

Patients with ESRD may have what cardiac problems?

A
  • LVH
  • Poor coronary blood flow
  • Myocardial fibrosis
  • Heart failure
  • Arrhythmias
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13
Q

What makes intra-op BP control difficult with ESRD patients?

A

diabetic autonomic neuropathy

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14
Q

How does autonomic neuropathy affect induction?

A

-Causes gastroperesis which increases risk of aspiration

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15
Q

CRF is causes anemia, what Hgb level is needed to ensure adequate O2 to transplanted graft?

A

-8

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16
Q

Patients on dailysis require what prior to surgery?

A

-Proper fluid and electrolyte balance

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17
Q

How is lung function impaired with ESRD?

A
  • Loss of elasticity
  • Loss of cough reactivity
  • decreased TV and FEV
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18
Q

What should be avoided intra-op with renal transplant?

A
  • Extremes in BP

- Tachycardia

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19
Q

What class of drugs should be avoided during renal transplant?

A

-Alpha adrenergic drugs

20
Q

Muscle relaxant choice for renal transplant is dependent on what?

A
  • K levels
  • Normal K = Sucs
  • Low K = Cisatricurium/Mivacurium
21
Q

When is succs used in renal transplants?

A
  • High risk of aspiration

- High dialysate levels

22
Q

What can be used if gastroperesis is a concerns for renal transplant?

A
  • Non-particulate antacid
  • Reglan
  • H2 blocker
23
Q

When can epidural anesthesia be used in renal transplantation? what are the benefits?

A
  • Coags and platelet are normal

- Decreased narcs and gas

24
Q

What type of drugs may be needed to increase CO and renal perfusion in order to have new kidney produce urine?

A

-Vasopressors / positive inotropes (dopamine,fenoldapam, norEpi, vasopressin)

25
Q

When is it appropriate to give mannitol or Loops during renal transplants? Why?

A
  • Before unclamping vascular supply to new kidney

- Enhance urine production

26
Q

What causes hypotension after reperfusion of grafted kidney? How to treat?

A
  • Unclamping the iliac artery

- Crystalloid,colloid, dopamine

27
Q

What is the significance of decreased UO after renal transplant? What tool can be used to identify

A

-Indicates problem w/ graft, anastamosing vessel or ureter

28
Q

What tool can be used to identify flow through newly grafted kidneys?

A

-ultrasound

29
Q

What may happen during emergence after renal transplant? What should be avoided?

A
  • Hypertension

- Beta Blockers (raise K)

30
Q

What are the anesthetic considerations for patients with prior renal transplant?

A
  • Decreased renal excretion
  • DM/HTN
  • Use cistactracarium
  • Adequate hydration
  • Avoid hypotension
31
Q

When can alcoholic cirrhosis be qualified for liver transplant?

A
  • no ETOH for 6 months

- ongoing therapy and evaluation

32
Q

Where do most livers come from? What is the focus?

A
  • heart beating cadaveric donors

- Preserving graft function

33
Q

chronic liver patients have what cardiac problems?

A
  • Hyperdynamic circulation
  • Low PVR
  • Increased CI
34
Q

What should be avoided with liver transplants?

A

-Nitrous

35
Q

Are hepatic metabolized drugs OK to use with liver transplants?

A

-yes

36
Q

What steps are done during the preanhepatic phase?

A
  • Lysis of adhesions and exploration
  • Mobilize liver
  • Dissection of hepatic artery, common bile duct, and portal vein
37
Q

When is a shunt used for liver transplants?

A

-w/ severe portal HTN that may cause significant blood loss

38
Q

What 4 things may happen during the preanhepatic phase?

A
  • Hemorrhage
  • Coag problems
  • Impaired venous return from IVC clamp
  • Hypocalcemia, hyperkalemia, metabolic acidosis
39
Q

What happens during the anhepatic phase?

A
  • Removal of old liver

- Implanting of donor liver

40
Q

What may occur from rapid infusion of bloodw/o liver function?

A

-Citrate intoxication

41
Q

When does the neohepatic phase begin? What is common during this phase?

A
  • unclamping of portal vein

- hemodynamic instability (reperfusion syndrome)

42
Q

Reperfusion syndrome is characterized by what?

A
  • decreased HR, BP, SVR
  • Rapid increase in K
  • Coagulopathies (fibrinolysis, heparin release, hypothermia)
43
Q

What should be normal prior to unclamping portal vein?

A

-Ph, electrolytes (K<4.5 )

44
Q

What are the signs of a functioning hepatic graft?

A
  • Intraop bile production
  • Intraop correction of neg base excess
  • Improving coags
45
Q

What are the indication for lung transplant?

A
  • COPD
  • Pulmonary fibrosis
  • Cystic fibrosis
  • alpha1-antitrypsin deficiency
  • Sarcoidosis
  • Congenital heart disease
46
Q

What happens to a heart after denervation?

A

-No sensory, no sympathetic, no parasympathetic responses.

47
Q

Where will the HR be after heart transplant and why?

A
  • HR should be high (90-110)

- No parasympathetic innervation.

AAN2 (11 decks)

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