Clinical Anesthesia | Renal

Question 1

Morphine has a DECREASED in protein binding on ESRD patients, hence, must have a reduction in initial dosing.

Answer 1

TRUE

Question 2

The active metabolite of HYDROMORPHONE is metabolized to hydro-glucuronide which accumulates in pt with renal failure.

Answer 2

TRUE

It can accumulate and cause cognitive dysfunction and myoclonus.

Barash | 9th edit

Question 3

cis-Atracurium metabolism results in lower LAUDANOSINE blood levels than does of ATRACURIUM in ESRD patients.

Answer 3

TRUE

Question 4

The best measure of of glomerular function:

A. Urine output
B. FENa
C. GFR
D. BUN

Answer 4

C. GFR

Question 5

At what spinal level does pain conduction of Testes is:

Answer 5

T10-L1

Question 6

At what spinal level does pain conduction of the neck of bladder is:

Answer 6

S2-S4

Question 7

At what spinal level does pain conduction of the dome of bladder is:

Answer 7

T11-L2

Question 8

Which of the following is the MOST accurate in describing the renal function of a neonate?

A) A urine output of < 1 mL/kg/hr is normal after 1 week of life

B) At birth, the glomerular filtration rate is low but it increases greatly in the first few days of life

C) At birth, the renal vascular resistance increases, which decreases blood flow to the kidneys

D) The increased glomerular filtration rate and increased tubular function allow for better concentration and dilution of urine

Answer 8

B) At birth, the glomerular filtration rate is low but it increases greatly in the first few days of life

Neonates have a low glomerular filtration rate (GFR) due to a high renal vascular resistance, low systemic arterial pressure, low permeability of the glomerular capillaries, and the small size of the glomerular capillaries.

At birth, a high systemic arterial pressure with a lower renal vascular resistance increases the amount of renal blood flow.

The GFR increases significantly in the first few days of life and reaches adult levels at 2 years of age.

This decreased GFR and tubular function impair the neonate’s ability to dilute and concentrate the urine. While the urine output is expected to be low on the first day of life, urine output afterward should be at least 1-2 mL/kg/hr.