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Principles of Anesthesia I EXAM 3 (Monte) > Exam 3 GU Procedures (7/15/24) > Flashcards

Exam 3 GU Procedures (7/15/24) Flashcards

1
Q

Symptoms of renal dysfunction begin to be seen when GFR drops to ___ from normal.

A

50%

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2
Q

Which of the following 3 symptoms begin to appear when there is “Severe” renal insufficiency?

A. Anemia
B. Profound Uremia
C. Decreased energy
D. Decreased BUN/Creatinine
E. Acidemia
F. Hypervolemia

A

B. Profound Uremia
E. Acidemia
F. Hypervolemia

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3
Q

BUN is not usually elevated in kidney disease until GFR is ___ of normal.

A

75%

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4
Q

While evaluating a CRF patient pre-operatively, you notice they are acidotic. Why IS this issue occuring?

A
  • Decreased production of ammonia

As disease progresses = anion gap becomes elevated

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5
Q

Specific Cardiac/Pulm symptoms that are likely to be present pre-operatively in CRF patients:

A
  • HTN
  • Atherosclerosis
  • Pulm. Edema
  • Vent. Hypertrophy
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6
Q

Which of the following are listed as “abnormal” in regard to the hematologic symptoms present in CRF patients?

A. Platelet Aggregation
B. Color
C. Size
D. Prothrombin Consumption

A

A. Platelet Aggregation
D. Prothrombin Consumption

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7
Q

Most of our anesthetic drugs are ___ in the ____ state, therefore aren’t very harmful in CRF patients.

A

Most drugs are lipid soluble in non-ionized state

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8
Q

List some anesthetic drugs of concern that are highly ionized and eliminated unchanged in urine:

A
  • Muscle relaxants (Pancuronium)
  • H2 receptor blockers
  • Cholinesterase inhibitors
  • Thiazide diuretics
  • Digoxin
  • Many antibiotics
  • Active Metabolites (morphine/meperidine/ketamine/midazolam)
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9
Q

What can we do to provide renal protection for renal insufficiency patients?

A

Adequate Hydration
Maintenence of adequate RBF
Maintain a normal MAP

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10
Q

Which of the following drugs has been shown to be most effective in offering renal protection to CRF patient’s after having dye injected?

A. Glucagon
B. Mannitol
C. Fenoldopam
D. N-Acetylcysteine
E. Methylene Blue

A

D. N-Acetylcysteine

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11
Q

Procedure name for using a scope to look through the bladder?

A

Cystoscopy

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12
Q

For which scope procedure would we definitely want to use a “Flexible” scope?

A

Ureteroscopy
(Easy to perf)

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13
Q

What is the procedure of choice for mid/distal ureter kidney stones?

A

Ureteroscopy

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14
Q

Lifetime prevalence of kidney stones for men and women?
Recurrence rate?
What are these stones comprised of?

A

Lifetime prevalence of kidney stones for men and women? (Men: 10%, Women: 5%)
Recurrence rate? (50%)
What are these stones comprised of? (Calcium)

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15
Q

What are some options for “Medical” therapy options for kidney stones?

A
  • NSAIDs
  • Aggressive fluid administration
  • Calcium channel Blockers
  • Alpha blockers
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16
Q

Surgical treatment options for kidney stones:

A
  1. Stone basket vs Laser
  2. Shock wave Lithotripsy
  3. Perc Nephrolithotomy
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17
Q

Which surgical treatment option is best suited for small/medium intranephrenic stones?

A

Shock Wave Lithotripsy

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18
Q

What were some issues seen with the older Shock wave lithotripsy procedures?

A
  • Required Water baths
  • High incidence of Hypothermia
  • Very Painful surgery
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19
Q

Absolute or Relative C/I to Shock wave lithotripsy:

Untreated UTI:
Morbid Obesity:
Pregnant:
Obstruction distal to renal caliculi:
Bleeding disorders:
Calcified Aorta:
Anti-coagulation therapy:
Pacemaker/ICD:

A

Untreated UTI: Relative
Morbid Obesity: Relative
Pregnant: Absolute
Obstruction distal to renal caliculi: Relative
Bleeding disorders: Absolute
Calcified Aorta: Relative
Anti-coagulation therapy: Absolute
Pacemaker/ICD: Relative

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20
Q

What is one thing that may be required for all OR personnel to wear during SWL?

A

Some dope protective eye-wear

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21
Q

Percutaneous Nephrolithotomy is useful for…
Requires initial placement of…
Possibility of…

A

Useful for large intranephric stones
initial placement of uretal stents
TUR syndrome is possible

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22
Q

Intra-Op considerations for Percutaneous Nephrolithotomy:

A
  • GETA
  • Short acting NMBD’s (Vec/Roc)
  • Lateral Positioning
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23
Q

True or False:
Orchiectomies are almost always unilateral with the affected side being most commonly the left side.

A

FALSE:
Orchiectomies are almost always bilateral

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24
Q

Testicular torsion must be resolved within ___ to avoid reversible ischemic damage.

A

6 hrs

Surgical Emergency!

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25
Q

What is one thing that may also be done if undergoing a penectomy?

A

May include inguinal lymph node biopsy
(Squamous cell carcinoma)

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26
Q

Patients with these 2 comorbidities are most likely to have a penile prosthesis operation:

A

Diabetes
Spinal cord Injury

Also can be done for impotence treatment, monitor for infection

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27
Q

For which 2 penile operations is a penile block most commonly done and appreciated?
What dermatomes are blocked?

A

Prosthesis and Penectomy

S2-S4

28
Q

True or False:
Men also run the risk of severe bradycardia due to manipulation of genitals causes reflex changes in vagal tone.

A

TRUE

29
Q

Indications for Cystectomy:

A
  1. Simple, benign cancer conditions
    * Hemorrhagic Cystitis
    * Radiation Cystitis
  2. Radical- Malignant conditions
    * Invasive bladder cancer
    * Also includes ureters, prostate, uterus, ovaries
30
Q

What are 2 other options aside from GETA for cystectomy cases?
What are some common complications?

A
  • SAB or Epidural
  • Blood Loss (up to 3L possible), Hypothermia, 3rd Space losses
31
Q

This procedure is the Gold-Standard for BPH:
What is the EBL for this procedure?

A

Transurethral Resection of Prostate

EBL of about 100-200 mls

32
Q

What is one intra-op consideration you as the anesthesia provider may need to make if you have a patient undergoing a Transurethral Resection of Prostate, and the surgeon performing the case is very slow…?

A

Perhaps you may choose to do a SAB over GETA, so you can have the patient awake and assess for symptoms of TUR syndrome.

In todays world, surgeons are usually faster so we dont need to worry

33
Q

TUR Syndrome symptoms most closely relate to what?
How does TUR syndrome happen?

A

Hypervolemic water intoxication
(Hyponatremia)

Shaving/scraping during the procedure opens many of the capillary beds, allowing excessive volume expansion through the venous sinuses.

34
Q

CNS and EKG changes for Na level of 120:

A

CNS: Confused, Restless

EKG: Possible widening of QRS

35
Q

CNS and EKG changes for Na level of 115:

A

CNS: Somnolence, Nausea

EKG: Elevated ST Segment, widened QRS

36
Q

CNS and EKG changes for Na level of 110

A

CNS: Seizures, Coma

EKG: V-Tach / V-Fib

37
Q

The use of any irrigant solution carries risks. What are the primary risks for Saline and Glycine?

A

Saline: Volume Overload, Na in NaCl can carry an electrocautery current = burns

Glycine: Metabolized in the liver to ammonia = high ammonia levels

38
Q

The use of any irrigant solution carries risks. What are the primary risks for hypotonic water and Sorbitol?

A

Water: Intravascular Hemolysis

Sorbitol: Metabolized to CO2 and fructose, volume overload

39
Q

Rate of the irrigation for Transurethral Resections of Prostate:
Range of how much is absorbed into venous sinuses:
How much is required to be classified as TUR Syndrome:

A

Irrigation rates 300ml/min

Absorption into venous sinuses = 20ml/min-200ml/min

Greater than 2L of absorption usually required for TUR syndrome

Can happen quick (100ml/min x 20 min = 2L)

40
Q

How can we prevent TUR syndrome from happening?

A
  • Limit resection time to 1 hour
  • Suspend the irrigating fluid < 30cm above the table
  • Treat hypotension from SAB with vasopressors NOT IVF
41
Q

Primary Method of treatment for TUR Syndrome:

A

ABC’s baby

Also stop the procedure ASAP, May need invasive lines

42
Q

If severe symptoms of TUR syndrome begin to appear (Na < 120), what should be administered?

A

3% IV Saline

43
Q

Considerations for Robotic Prostatectomy:

A
  • Arterial line
  • Phenylephrine drips
  • LIMIT IV fluids
44
Q

Up to ___ of patients undergoing a nephrectomy experience post-op complications.

A

20%

45
Q

Primary difference between a simple and a radical nephrectomy:

A

Radical includes the adrenal glands

46
Q

Positioning for a nephrectomy is most similar to what other procedure discussed previously?

A

Spleenectomy

47
Q

Which of the following are correct regarding anesthesia implications for a nephrectomy? (Select 3)

A. Use an LMA
B. Consider a CVL on the contralateral side to the surgical site
C. Type/Cross and Type/Screen may be necessary along with 2 IV’s
D. Consider regional anesthesia due to the high pain levels associated post-operatively
E. GETA
F. Avoid giving anxiolytics pre-op

A

C. Type/Cross and Type/Screen may be necessary along with 2 IV’s
D. Consider regional anesthesia due to the high pain levels associated post-operatively
E. GETA

Rationale: GETA > LMA. Consider a CVL on the ipsilateral side to the surgical site. Giving anxiolytics pre-op is encouraged.

48
Q

Which kidney is the usual choice for kidney transplantation and why?

A

Left!

The vessels are longer, allow for more room to work

49
Q

Mom is recieving a donor kidney from her daughter. Who will be induced for surgery 1st?

A

Daughter: donor starts a couple of hours prior to recipient

50
Q

About what percent of all renal nephrectomies are from living donors?

A

about 1/3 (33%)

51
Q

What dose range of IVF would you give for a kidney donor weighing 80 kgs?

A

800-1600 mls/hr

Aggressive isotonic hydration (10-20 ml/kg/hr)

52
Q

Aside from IVF what other medications will the donor need intra-op or post-op?

A
  • Low level anticoagulation (5000u of Heparin)
  • 50 mg of Protamine once the kidney is out
  • Diuresis (Lasix, Mannitol)
53
Q

Neurological Issues for a DBD:

A
  • Cushing’s sign…HTN, bradycardia, wide pulse pressure
  • Catastrophic ICP elevation
54
Q

Cardiac Issues for a DBD:

A
  • Massive release of catecholamines
  • Acute MI is common
  • Cardiovascular collapse
55
Q

Pulmonary Issues for a DBD:

A
  • Neurogenic pulmonary edema
  • SIRS
56
Q

Metabolic Issues for a DBD:

A
  • Dysfunction of hypothalamus and pituitary systems
  • Alterations in thermoregulation, hormones, insulin, electrolytes, DIC
57
Q

When performing anesthesia for a cadaver donor, what should we give for significant bradycardia?
Why this drug specifically?

A

Isoproterenol

Significant bradycardia not responsive to anticholinergics (such as atropine)

58
Q

Long list of Donor Management Goals…

A
59
Q

Pre-op evaluations for recipient of a new kidney:

A
  • Last Dialysis (K level)
  • Blood glucose
  • EKG/Angiogram?
60
Q

What options for a NMBD, do we have for a patient receiving a donor kidney, with a K of 5.2?

A

Most likely we should give Cisatracurium (No clearance by Liver/Kidney)
Avoid Succs here = K will rise even more

61
Q

True or False:
Use of Aseptic technique when inserting an arterial line to a recipient of a donor kidney is acceptable.

A

FALSE!

Must use STERILE technique

62
Q

Which of the following is the correct order of how the donor kidney should be anastomosed to the recipient.

A. Vein –> Ureter –> Artery
B. Artery –> Vein –> Ureter
C. Vein –> Artery –> Urethra
D. Ureter –> Artery –> Vein
E. Vein –> Artery –> Ureter
F. Ureter –> Vein –> Artery

A

E. Vein –> Artery –> Ureter

(If you picked C, please refer back to Papa Schmidt: “Read Carefully”)

63
Q

What is given after the donor kidney has been correctly placed into the recipient to prevent/treat acute rejection?

What is this?

A

Anti-thymocyte

Infusion of rabbit-derived antibodies against human T cells to prevent/treat acute rejection

64
Q

True or False:
Most people after receiving a new kidney have “Cytokine release syndrome”?

What is done if this occurs?

A

True!

Treat the SYMPTOMS of fever, chills rigors
(Steroids, Benadryl, ACET)

65
Q

Differentiate DBD from DCD

A

DBD: Donor after brain death
DCD: Donor after cardiac death

66
Q
A

Principles of Anesthesia I EXAM 3 (Monte) (5 decks)

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