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BioScience II > Effects of Anesthesia and sx on Renal fx-Josh > Flashcards

Effects of Anesthesia and sx on Renal fx-Josh Flashcards

1
Q

Effects are typically less w/ _____ vs _____ anesthesia

A

less w/ Regional vs General

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2
Q

anesthesia put ______ decreases in RBF, GFR, urininary flow, and Na+ excretion

A

Reversible

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3
Q

Most renal changes from anesthesia are not direct but mediated by ____ and _____ influances

A

autonomic and hormonal influences

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4
Q

Anesthesia and Surgery effects on Renal Fxn:

Most changes can be partially overcome by maintaing what?

A

adequate intravascular volume and Normotension

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5
Q

Anesthesia and Surgery effects on Renal Fxn:

there are very few anesthetics we administer such as _____ and ____ which in high doses can potentially cause specific renal toxicity

A

enflurane

Sevoflurane (it got all those F’s)

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6
Q

Anesthesia and Surgery effects on Renal Fxn:

Most inhalation and IV drugs cause some degree of cardiac depression and/or vasodilation and can decrease ____ ____

A

Arterial BP (thus decreasing RBF)

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7
Q

Anesthesia and Surgery effects on Renal Fxn:

how does regional anesthesia effect RBF?

A

sympathectomy

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8
Q

Anesthesia and Surgery effects on Renal Fxn:

decreases in BP below the level of autoregulation can ultimately decrease what 4 things?

A
  1. RBF
  2. GFR
  3. Urinary flow
  4. Na+ excretion
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9
Q

Anesthesia and Surgery effects on Renal Fxn:

some neural effects such as sympathetic activation (from light anesthesia) can increase renal vascular resistance and activate hormonal systems. both tend to decrease what?

A

GFR

RBF

UOP

(remember you’ll never stop to take a piss if being chased by a man eating Lama)

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10
Q

Anesthesia and Surgery effects on Renal Fxn:

endorine effects:

Stress responce related to surgical stimulation, CV depression, Hypoxia, or acidosis, all will cause an increase in catecholamines, ADH, and AT II. ALL that will reduce RBF how?

A

by induducing renal artery constriction

and aldosterone enhances Na+ reabsorption

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11
Q

Anesthesia and Surgery effects on Renal Fxn:

how does Pneumoperitoneum or PEEP effect renal system

A
  • Abdominal compartment syndrome like
  • d/t renal vein and vena cava compression
  • leads to an increased renin, aldosterone, and ADH release
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12
Q

Anesthesia and Surgery effects on Renal Fxn:

how does CPB effect the renal system

A

Non oulsatile flow

production of free radicals

decreased renal perfusion at cross clampt ime

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13
Q

Anesthesia and Surgery effects on Renal Fxn:

how does pelvic sx effect the renal system?

A

compression of the bladdder by retractors

Ligation of ureters

trendelenburg position impeding emptying of bladder

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14
Q

Anesthesia and Surgery effects on Renal Fxn:VAA

release of Fluride Ions from VAA metabolic degradation w/ plasma comcentration > _______ have been associated w/ renal toxicity?

A

> 50 micromol/L

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15
Q

Anesthesia and Surgery effects on Renal Fxn:VAA

floride production is negligible w/ halothane, desflurane, and iso, but the greatest w/ prolonged use of ____ and especially ____

A

enflurane

Sevoflurane

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16
Q

Anesthesia and Surgery effects on Renal Fxn:VAA

as we know in Lab rate ONLY sevo at low flows can produce _____ ____ which can cause renal damage?

A

Compound A

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17
Q

Anesthesia and Surgery effects on Renal Fxn:VAA

overall b/c of low metabolism/kidney excretion VAAs may be the ______ anesthetic for pts w/ impaired renal functions?

A

Safest

(found this very interesting)

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18
Q

Anesthesia and Surgery effects on Renal Fxn: IV agents

which drugs inhibnit prostaglandin sysnthesis preventing the renal production of vasodilatory prostaglanding in pts with high levels of ATII and Norepinephrine

A

NSAIDS

19
Q

Anesthesia and Surgery effects on Renal Fxn: IV agents

what drugs block the protective effects of AT II and may result in additional reductions in GFR during sx

A

ACE inhibitors

20
Q

Anesthesia and Surgery effects on Renal Fxn: IV agents

what other drugs cause renal artery vasospasms, direct cytoxic injury or renal/tubular obstruction?

A

Aminoglycosides

Immunosuppresive agents

Radiocontrast dyes

21
Q

Anesthesia and Surgery effects on Renal Fxn:

W/ aortic cross clamping regardless where the position of the clamp is RBF is decreased ____%

A

50%

22
Q

Anesthesia and Surgery effects on Renal Fxn:

release of the cross clamp causes an increase in RBF, but GFR is impaired to only 2/3 of normal for up to how long

A

24 hrs

23
Q

manifestations of Renal Failure:

what electrolytes/ cells are increased in renal failure?

A

K+

Phasphate

Mg

Uric acid

24
Q

manifestations of Renal Failure:

what electrolytes/ cells are decreased in renal failure?

A

Ca++

Albumiin

RBC production

25
Q

manifestations of Renal Failure:

what happens to CO in response to decreased O2 carrying capacity, by means of Na+ retention on RAAS

A

Increases

26
Q

manifestations of Renal Failure:

the increased sytemic HTN leads to what?

A

LVH

27
Q

Fluid management:

avoid what w/ hyperkalemic pts?

A

LR

28
Q

Fluid management:

use _____ free solutions?

A

glucose free

29
Q

Fluid management:

blood loss shpould generally be replaced w/ what?

A

PRBCs

30
Q

Electrolyte disturbances:

normal Na+

A

135-145 mEq/L

31
Q

Electrolyte disturbances:

serious manifestation of hyppoNa+ are generally associated w/ plasma Na+ concentrations of what?

A

<120 mEq/L

32
Q

Electrolyte disturbances:

plasma concentrations of Na+ > what are generally safe for GA

A

>130 mEq/L

33
Q

Electrolyte disturbances:

why should you caution rapid correction of hyponatremia?

A

b/c it has been associated w/ demyelinated lesions in the pons resulting in serious permanent neurological condictions

34
Q

Electrolyte disturbances:

HyPERnatremia _____ the MAC for inhaled anesthetics in animal studies?

A

increases

35
Q

Electrolyte disturbances:

electrive procedures should be postponed in pt’s w/ significant hypernatrema > ______

A

> 150mEq/L

36
Q

Electrolyte disturbances: Potassium

normal levels?

A

3.5-5 mEq/L

37
Q

Electrolyte disturbances: Potassium

what do you want to avoid in cases of high K+

A

LR

Resp acidosis

38
Q

Electrolyte disturbances: Potassium

what causes hypoK+

A

diuresis

antibiotic

NGT

insulin

Acute alkolosis

39
Q

Electrolyte disturbances: Potassium

what causes hyperK+

A

rhabdomyolysis

SCh

renal failure

K sparing diuretics

ACE inhibitors

NSAIDS

40
Q

Electrolyte disturbances: Calcium

normal value for ionized

A

1.1-1.4 mmol/L

41
Q

Electrolyte disturbances: Magnesium

Normal values

A

1.7-2.1 mEq/L

42
Q

What is TURP syndrome/ how does it occur?

A
  • Prostate tissue is resected and large amounts of irrigation are used
  • Eectroltye solution can NOT be used d/t cautery, thus slightly hypotonic/non-electrolyte solution are used
  • Open venous sinuses in the prostate and ressure of irrigation fluid allow systemic absorption of the irrigation fluid (2L or more)
  • can present intraop or post op
  • monitor Na+ levels
43
Q

whoo enough fucking renal

A

&*&%^% that sucked

BioScience II (39 decks)

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