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RUSVM Anesthesiology 2016 > CNS, Renal, And Hepatic Disease > Flashcards

CNS, Renal, And Hepatic Disease Flashcards

1
Q

What are common Renal elective procedures?

A

Dental

Mass Removal

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2
Q

What are common Renal Non-elective procedures?

A

Urethral stones
renal transplant
renal tumor

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3
Q

What are common Renal Emergency procedures?

A

Feline urethral obstruction

Ruptured Bladder

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4
Q

What are the three main functions of the kidneys?

A

Filtration
Reabsorption
Secretion

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5
Q

How much cardiac output do the kidneys receive?

A

25%

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6
Q

What does reabsorption depend on?

A 
Aldosterone
ADH 
Renin-angiotensin
atrial natriuretic factor
prostaglandins
catecholamines
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7
Q

What are kidneys sensitive to?

A

Ischemia

Hypoxia

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8
Q

What is the constant mean arterial pressure of the Renal blood flow?

A

80-180mmHg

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9
Q

What drugs should you avoid for the renal disease?

A

Anesthetics causing hypotension or requiring renal excretion
NSAIDs

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10
Q

What Pre-op management should happen with Renal Compromise?

A

Fluid diuresis

Attention to electrolyte status (including Ca and Mg) with supplementation as necessary

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11
Q

What Intra-op management should happen with Renal Compromise?

A

IV Fluids

MAP should be maintained about 70-80mmHg

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12
Q

What is the fluid rate for renal compromised patients?

A

10mg/kg/hr

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13
Q

What should you do first with a patient with Feline Urethral Obstruction?

A

Stabilize: Hyperkalemia and Hypovolemia

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14
Q

How do you treat Hyperkalemia in a cat with Urethral Obstruction?

A

Calcium gluconate

Regular Insulin + dextrose

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15
Q

How do you treat Hypovolemia in a cat with Urethral Obstruction?

A

Buffered isotonic IV fluids

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16
Q

What drugs do you use in Feline Urethral obstruction?

A

Cardiovascular-sparing drugs: Opioids and Benzos

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17
Q

What drugs do you avoid in Feline Urethral obstruction?

A

Ketamine

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18
Q

What is the MAP that must be maintained for normal cerebral blood flow?

A

50-150mmHg

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19
Q

What is the equation for Cerebral perfusion pressure?

A

MAP - ICP

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20
Q

Cushing Reflex

A

Severe Increase ICP leading to poor cerebral perfusion
Leads to sympathetic response: vasoconstriction, increased cardiac output leading to hypertension
Carotid baroreceptors sense hypertension and cause reflex bradycardia
Increased ICP causes dysfunction of respiratory center causing irregular breathing pattern

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21
Q

What are the preferred drugs for patients with CNS disease?

A

Do not increase ICP
cause seizures or lower seizure threshold
Decrease Cerebral blood flow

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22
Q

Acepromazine - CNS effects

A

decrease seizure threshold

23
Q

Benzodiazepines - CNS effects

A

Decrease Cerebral Blood Flow and ICP

Control seizures

24
Q

Opioids - CNS effects

A

Minimal effects on Cerebral Blood Flow and ICP

25
Q

What are the side effects of Opioids?

A

Vomiting
hypoventilation
increase ICP

26
Q

What drug is used for CRI maintenance of anesthesia in CNS disease?

A

Propofol

27
Q

Etomidate - CNS effects

A

Decreases ICP, CBF< and CMRO2

28
Q

Ketamine - CNS effects

A

Increases ICP and CBF

May cause seizures

29
Q

Succinylcholine - CNS effects

A

Increases ICP

30
Q

What are the CNS effects of inhalational anesthetics?

A

at greater than 1 MAC increase CBF and ICP via cerebral vasodilation

31
Q

Which inhaled anesthetic has the greatest CNS effects?

A

Halothane

32
Q

What do you do for Intracranial disease during anesthesia?

A

Maintain straight neck and head slightly elevated
Prevent vomiting/coughing
Prevent hyperglycemia, hypercapnia, hypoxemia
Conservative fluid recuccitation
Mannitol before induction if increased ICP is suspected

33
Q

Trendelenburg-lie positioning

A

In horses: head down positioning in isoflurane anesthetized horses increases ICP by 80% and decreases CBF 20%

34
Q

Equine intracarotid injection

A

causes violent behavioral reaction and seizures

35
Q

How do you treat seizures from Equine Intracarotid injection?

A

Thiopental +/- guafenesin

Supplemental O2 and fluids

36
Q

What are the functions of the Liver?

A 
Protein metabolism 
Carbohydrate metabolism 
Fat metabolism
Vitamin storage 
Iron storage 
Produces coagulation factors
Immune function 
Metabolizes Drugs, hormones, toxins
37
Q

What are the clinical signs of liver disease?

A 
Depression 
anorexia
weight loss
Icterus 
ascites
abnormal behavior 
seizures
38
Q

What drugs may worsen the signs of hepatic encephalopathy?

A

Benzodiazepines

39
Q

What are the drug considerations for Liver disease?

A

Liver metabolizes most anesthetic drugs so the drug action will be increased and/or prolonged
Many drugs are highly protein bound so hypoproteinemia can will cause higher blood levels

40
Q

What are the pre-anesthetic considerations for Liver disease?

A

Optimize perfusion
Correct hypoglycemia and electrolyte disturbances
Abdominocentesis for ascites
Blood type and crossmatch

41
Q

What drugs should you avoid in gallbladder disease?

A

Opioids

42
Q

What are the preferred drugs of liver disease?

A

Propofol
Opioids
Alfaxalone
Etomidate

43
Q

Which inhalation anesthetic increases total hepatic blood flow?

A

Isoflurane

44
Q

What inhalation anesthetics decrease portal vein and total hepatic blood flow?

A

Sevoflurane

Des

45
Q

Which local anesthetics are metabolized by the liver?

A

Lidocaine
Bupivicaine
Mepivacaine

46
Q

Why is Acepromazine is contraindicated in liver disease?

A

Vasodilation
Decreased BP
Inhibits platelet aggregation

47
Q

Why are alpha 2 agonists contraindicated in liver disease?

A

Decreased CO

48
Q

Why are barbiturates contraindicated in liver disease?

A

Extensively redistributed, dependent on hepatic metabolism

Highly protein bound

49
Q

Why is halothane contraindicated in liver disease?

A

Decreased hepatic blood flow
Metabolized by liver
Hepatopathy

50
Q

Why is Succinylcholine contraindicated in liver disease?

A

Cholinesterases synthesized by liver

51
Q

Why is Guaifenesin contraindicated in liver disease?

A

Metabolized in liver

Metabolite (catechol) can cause toxic neuro effects

52
Q

What are the intra-op considerations for liver disease?

A 
Maintain liver perfusion 
Monitor glucose
Monitor hemorrhage 
Monitor depth of anesthesia, drug requirements may be decreased 
Maintain normal body temperature
53
Q

What are the Post-op considerations for liver disease?

A

Check acid/base status, electrolytes, glucose, and pcv/tp
Maintain body temp
Monitor for neurological abnormalities

54
Q

What is important for Portosystemic shunt ligation?

A

Arterial BP monitoring

RUSVM Anesthesiology 2016 (38 decks)

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