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Anesthesia Principles 2 > Exam 3: Renal 2/2 > Flashcards

Exam 3: Renal 2/2 Flashcards

1
Q

Fluid resuscitation for ARF

A

Colloid vs. Crystalloids controversy
MAP > 80mmHg

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2
Q

Vasopressors in ARF - you are concerned about what?

A

concern of renal vasoconstriction increased

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3
Q

Dopamine in ARF?

A

not supported by literature to treat or prevent ARF

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4
Q

True or False. CKD is reversible.

A

False.

CKD, or chronic renal failure, is a slow, progressive, irreversible condition characterized by diminished functioning of nephrons and a decrease in renal blood flow, GFR, tubular function, and reabsorptive capacity.

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5
Q

Causes of chronic kidney disease:

A
  • Glomerulopathies
  • Tubulointerstitial diseases
  • Heredity diseases
  • Systemic hypertension
  • Renal vascular disease
  • Obstructive uropathy
  • Human immunodeficiency virus infection
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6
Q

Anesthetic Management of chronic renal insufficiency - PREOP

A
  • Concomitant drug therapy
  • Clinical manifestations of disease
  • Glucose management (inquire about insulin use)
  • Antihypertensive therapy continued
  • Dialysis in the 24 hours preceding surgery
  • Serum K+ < 5.5 mEq/L
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7
Q

Anesthetic Management of chronic renal insufficiency - INDUCTION

A
  • ? RSI
  • Slow induction
  • Respond to induction as if hypovolemic
  • PPV affects blood volume
  • Succ and K+ levels
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8
Q

Anesthetic Management of chronic renal insufficiency - MAINTENANCE

A
  • Inhalation agent choice
  • Nitrous oxide
  • TIVA
  • Possible liver disease
  • Pros/Cons inhalation agents
  • Muscle Relaxants (cisatracurium, atracurium are good for renal patients) - but cisatracurium is better cuz atracurium releases histamine
  • Fluid management
  • Monitoring
  • Regional Anesthesia
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9
Q

What is the extreme form of chronic renal failure with surviving nephron population and GFR dropping to < 10%?

It reflects kidneys inability to perform functions of water and electrolyte balance

A

Uremic Syndrome

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10
Q

S/Sx of uremic syndrome

A

anorexia, nausea, vomiting, pruritus, anemia, fatigue, coagulopathy

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11
Q

What lab test is a useful indicator of the severity of uremic syndrome?

A

BUN

(Serum creat correlates poorly with sx)

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12
Q

Treatment of uremic syndrome

A

dietary protein restriction based on presumption that low protein diet results in decreased protein catabolism and urea production

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13
Q

Complications of Uremic Syndrome

A

Hyponatremia
Hyperkalemia
Metabolic acidosis
Heart failure
HTN
Myocardial dysfunction

Pulmonary edema
Central hyperventilation
Anemia
Delayed gastric emptying
Encephalopathy
Seizures

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14
Q

Approximately 80% of upper urinary tract stones are ______ based (composed of calcium oxalate, calcium phosphate, or brushite)

A

calcium

(most stones are calcium oxalate)

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15
Q

Are stones in the renal pelvis painful or painless?

A

Painless

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16
Q

Are stones in the renal ureters painful or painless?

A

Painful

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17
Q

What is a TURP procedure?

A

Transurethral resection of the prostate

The procedure consists of opening the outlet channel from the bladder using a resectoscope in the urethra to electrically cut away the obstructing median and lateral lobes of prostate tissue.

18
Q

Nephrolithiasis s/sx

A

Flank pain (intense pain)
Hematuria

19
Q

_____________ is a very effective noninvasive treatment for urinary stones. The technique uses high-energy ultrasonic or pneumatic shock waves or lasers to fragment renal calculi into small particles.

A

Extracorporeal shock wave lithotripsy (ESWL)

20
Q

S/Sx of TURP Syndrome

A

The hallmark clinical symptoms are procedure related due to a combination of water intoxication, fluid overload, and hyponatremia.

21
Q

What are the disadvantages of using Glycine 1.5% in TURP procedures?

A

Hyperglycinemia
Hyperammonemia

22
Q

What is the most common irrigation fluid used for TURP procedures?

A

Glycine 1.5%

23
Q

What are absorption factors related to TURP procedures that can result in TURP syndrome

A
  • number and size of open venous sinuses
  • duration of resection
  • hydrostatic pressure of the irrigating fluid
  • venous pressure at the irrigant-blood interface.
24
Q

What are ways to avoid the absorption of irrigation fluid in a TURP procedure?

A
  • resection time < 1hr
  • bag no > 30cm from bed at the beginning and 15 cm during the final stages of resection
  • avoid hypotonic solution
  • tx Regional Anes induced HOTN
25
Q

Treatment of TURP Sydrome

A
  1. Ensure oxygenation and circulatory support.
  2. Notify surgeon and terminate procedure as soon as possible.
  3. Consider insertion of invasive monitors if cardiovascular instability occurs.
  4. Send blood to laboratory for evaluation of electrolytes, creatinine, glucose, and arterial blood gases.
  5. Obtain 12-lead electrocardiogram.
  6. Treat mild symptoms (with serum Na+ concentration >120 mEq/L) with fluid restriction and loop diuretic (furosemide).
  7. Treat severe symptoms (if serum Na+ <120 mEq/L) with 3% sodium chloride IV at a rate <100 mL/hr.
  8. Discontinue 3% sodium chloride when serum Na+ >120 mEq/L.
26
Q

Advantages of Neuraxial Block for a TURP

A
  • Ability to assess the patient’s level of consciousness for TURP syndrome
  • Ability to assess chest pain, SOB caused by myocardial ischemia and volume overload
  • Ability to assess abdominal pain caused by bladder perforation
  • Decreased vascular resistance will less possibility of hypervolemia
  • Controversial if neuraxial blockade decreases blood loss during TURP
27
Q

Disadvantages of Neuraxial Block for a TURP

A
  • Moderate to severe HOTN can occur and potentiated in patients taking alpha-adrenergic antagonists for BPH
  • Placement can be difficult due to arthritic changes in aging population
  • Decreasing venous resistance increases amount of irrigant that is absorbed through open venous sinuses
  • Dysphoria from benzos, narcotics or other CNS depressants given
28
Q

What is the most common type of bladder rupture?

A

Extraperitoneal is most common type (80% of cases)

29
Q

True or False. Blunt trauma more likely to result in intraperitoneal rupture in children than in adults.

A

True

30
Q

_____ bladder rupture requires surgical repair and _______ bladder rupture can be treated conservatively.

A

Intraperitoneal; extraperitoneal

31
Q

S/Sx of Extraperitoneal Bladder Rupture

A
  • Discomfort (Periumbilical, Inguinal, Suprapubic)
  • Periumbilical/inguinal tissue distension
32
Q

S/Sx of Intraperitoneal Bladder Rupture

A
  • Discomfort (Chest, Upper abdomen, Shoulder tip - diaphragmatic irritation)
  • Nausea and vomiting
  • Abdominal rigidity
  • Shortness of breath
  • Diaphoresis
  • Hiccups
33
Q

What are the only volatiles to directly cause renal dysfunction?

A

Methoxyflurane & enflurane

34
Q

Free fraction of an induction dose of ______ is almost doubled in patients with renal failure

A

thiopental

(we don’t really see this in anesthesia anymore - it is seen in lethal injection)

35
Q

What are you concerned about with benzos with CKD patients?

A

CKD increases the free fraction of benzodiazepines in the plasma, and this potentiates their clinical effect

36
Q

True or False. Meperidine is not recommended for use in patients with poor renal function

A

True

37
Q

What is the site of action of acetazolamide in the nephron?

A

PCT

38
Q

What is the site of action of osmotic diuretic (such as mannitol) in the nephron?

A

Descending limb of the Loop of Henle

39
Q

What is the site of action of Loop diuretics (furosemide) in the nephron?

A

Ascending limb of the Loop of Henle

40
Q

What is the site of action of Thiazide diuretics in the nephron?

A

Distal convoluted tubule

Anesthesia Principles 2 (4 decks)

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