ESRD Flashcards

1
Q

What concerns do you have about providing anesthesia to an ESRD patient?

A
  • electrolyte abnormalities (hyperK, hypoCa, hyperglycemia)
  • metabolic acidosis
  • cardiac conduction blockade
  • CHF
  • bleeding (uremia causes impaired vWF causes impaired PLT function)
  • altered drug clearance
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2
Q

what ways do you treat hyperK?

A
  • calcium
  • glucose/ insulin
  • B-2 agonist
  • hyperventilation
  • bicarbonate
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3
Q

What do you do if someone has a transplanted kidney and you need to give blood?

A
  • try to avoid
  • exposure to leukocyte antigens cause alloantibodies
  • washed (leuko-reduced), irradiated (less GVHD), CMV negative
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4
Q

What drugs have prolonged clearance in ESRD pts?

A
  • pancuronium
  • atropine, glyco
  • ketamine
  • morphine
  • benzos
  • meperidine
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5
Q

ESRD pt needs hemicolectomy. How would you do fluid replacement?

A
  • avoid fluid overload
  • limit replacement to 1-2cc/kg/hr
  • replace blood using blood/colloid, not 3:1 fluids
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6
Q

Often times heparin is used during dialysis, how long after heparinization do you need to wait for neuraxial intervention?

A
  • wait 4-6hrs after NA before hep in HD

- when removing, make sure removal is at least an hour before heparinization in HD

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7
Q

For UFH, how long do you wait if SQH 5,000 U (for NA placement)? What about 7.500 U? 10,000 U?

A

5000U = wait 4-6hrs before NA
the effect of UFH takes 1hr to kick in

7500U = 12hrs

> 10,000U = 24hrs

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8
Q

How long do you wait for NA if hep gtt stopped?

A
  • wait 4-6hrs after heparin has been stopped

- after epidural placed or removed, wait 1hr until restarted

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9
Q

for LMWH how long do you wait for NA if low dose? high dose?

A

low dose = 12hrs
high dose = 24hrs
if LMWH for 4days+ check PLT for HIT

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10
Q

How long o you wait for NA if on Xa agent? Rivaroxiban, apixiban, edoxaban, betrixaban?

A

wait 72hrs (3 days)

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11
Q

How long o you wait for NA if on direct thrombin inhibitor? Argatroban? Dabigatran?

A

delay for 72 to 120hrs depending on Cr clearance

monitor aPTT

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12
Q

How long o you wait for NA if on clopidogrel?

A

wait 5- 7 days

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