Exam 3: Renal 2/2 Flashcards
Fluid resuscitation for ARF
Colloid vs. Crystalloids controversy
MAP > 80mmHg
Vasopressors in ARF - you are concerned about what?
concern of renal vasoconstriction increased
Dopamine in ARF?
not supported by literature to treat or prevent ARF
True or False. CKD is reversible.
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.
Causes of chronic kidney disease:
- Glomerulopathies
- Tubulointerstitial diseases
- Heredity diseases
- Systemic hypertension
- Renal vascular disease
- Obstructive uropathy
- Human immunodeficiency virus infection
Anesthetic Management of chronic renal insufficiency - PREOP
- 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
Anesthetic Management of chronic renal insufficiency - INDUCTION
- ? RSI
- Slow induction
- Respond to induction as if hypovolemic
- PPV affects blood volume
- Succ and K+ levels
Anesthetic Management of chronic renal insufficiency - MAINTENANCE
- 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
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
Uremic Syndrome
S/Sx of uremic syndrome
anorexia, nausea, vomiting, pruritus, anemia, fatigue, coagulopathy
What lab test is a useful indicator of the severity of uremic syndrome?
BUN
(Serum creat correlates poorly with sx)
Treatment of uremic syndrome
dietary protein restriction based on presumption that low protein diet results in decreased protein catabolism and urea production
Complications of Uremic Syndrome
Hyponatremia
Hyperkalemia
Metabolic acidosis
Heart failure
HTN
Myocardial dysfunction
Pulmonary edema
Central hyperventilation
Anemia
Delayed gastric emptying
Encephalopathy
Seizures
Approximately 80% of upper urinary tract stones are ______ based (composed of calcium oxalate, calcium phosphate, or brushite)
calcium
(most stones are calcium oxalate)
Are stones in the renal pelvis painful or painless?
Painless
Are stones in the renal ureters painful or painless?
Painful
What is a TURP procedure?
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.
Nephrolithiasis s/sx
Flank pain (intense pain)
Hematuria
_____________ 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.
Extracorporeal shock wave lithotripsy (ESWL)
S/Sx of TURP Syndrome
The hallmark clinical symptoms are procedure related due to a combination of water intoxication, fluid overload, and hyponatremia.
What are the disadvantages of using Glycine 1.5% in TURP procedures?
Hyperglycinemia
Hyperammonemia
What is the most common irrigation fluid used for TURP procedures?
Glycine 1.5%
What are absorption factors related to TURP procedures that can result in TURP syndrome
- number and size of open venous sinuses
- duration of resection
- hydrostatic pressure of the irrigating fluid
- venous pressure at the irrigant-blood interface.
What are ways to avoid the absorption of irrigation fluid in a TURP procedure?
- 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
