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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
When is it appropriate to give mannitol or Loops during renal transplants? Why?
- Before unclamping vascular supply to new kidney | - Enhance urine production
26
What causes hypotension after reperfusion of grafted kidney? How to treat?
- Unclamping the iliac artery | - Crystalloid,colloid, dopamine
27
What is the significance of decreased UO after renal transplant? What tool can be used to identify
-Indicates problem w/ graft, anastamosing vessel or ureter
28
What tool can be used to identify flow through newly grafted kidneys?
-ultrasound
29
What may happen during emergence after renal transplant? What should be avoided?
- Hypertension | - Beta Blockers (raise K)
30
What are the anesthetic considerations for patients with prior renal transplant?
- Decreased renal excretion - DM/HTN - Use cistactracarium - Adequate hydration - Avoid hypotension
31
When can alcoholic cirrhosis be qualified for liver transplant?
- no ETOH for 6 months | - ongoing therapy and evaluation
32
Where do most livers come from? What is the focus?
- heart beating cadaveric donors | - Preserving graft function
33
chronic liver patients have what cardiac problems?
- Hyperdynamic circulation - Low PVR - Increased CI
34
What should be avoided with liver transplants?
-Nitrous
35
Are hepatic metabolized drugs OK to use with liver transplants?
-yes
36
What steps are done during the preanhepatic phase?
- Lysis of adhesions and exploration - Mobilize liver - Dissection of hepatic artery, common bile duct, and portal vein
37
When is a shunt used for liver transplants?
-w/ severe portal HTN that may cause significant blood loss
38
What 4 things may happen during the preanhepatic phase?
- Hemorrhage - Coag problems - Impaired venous return from IVC clamp - Hypocalcemia, hyperkalemia, metabolic acidosis
39
What happens during the anhepatic phase?
- Removal of old liver | - Implanting of donor liver
40
What may occur from rapid infusion of bloodw/o liver function?
-Citrate intoxication
41
When does the neohepatic phase begin? What is common during this phase?
- unclamping of portal vein | - hemodynamic instability (reperfusion syndrome)
42
Reperfusion syndrome is characterized by what?
- decreased HR, BP, SVR - Rapid increase in K - Coagulopathies (fibrinolysis, heparin release, hypothermia)
43
What should be normal prior to unclamping portal vein?
-Ph, electrolytes (K<4.5 )
44
What are the signs of a functioning hepatic graft?
- Intraop bile production - Intraop correction of neg base excess - Improving coags
45
What are the indication for lung transplant?
- COPD - Pulmonary fibrosis - Cystic fibrosis - alpha1-antitrypsin deficiency - Sarcoidosis - Congenital heart disease
46
What happens to a heart after denervation?
-No sensory, no sympathetic, no parasympathetic responses.
47
Where will the HR be after heart transplant and why?
- HR should be high (90-110) | - No parasympathetic innervation.

AAN2 (11 decks)

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