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2-General Anesthesia Exam 2 > Fluid Resuscitation-Colloids > Flashcards

Fluid Resuscitation-Colloids Flashcards

1
Q

What are some examples of colloids?

A

Hetastarch
Dextran
Albumin
Gelatin

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2
Q

What type of colloid is hetastarch 6%?

A

Synthetic colloid

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3
Q

What are the types of hetastarch 6%?

A

Hespan & Hextend

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4
Q

What is hespan?

A

6% high-MW hetastarch in saline

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5
Q

What is hextend?

A

6% high-MW hetastarch in balanced electrolytes

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6
Q

What is the cost of hetastarch?

A

Low cost

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7
Q

What is hetastarch associated with?

A

Associated with dose dependent coagulopathy due to hemodilution and binding of clotting factors, interference with platelet adhesion and changes in plasma viscosity

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8
Q

What does hetastarch provide?

A

plasma expansion for 24-36 hours

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9
Q

What are disadvantages to hetastarch? (3)

A

Hyperglycemia, allergic reaction, coagulopathy

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10
Q

What is the dose of hetastarch?

A

15-30ml/kg/day

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11
Q

Where is hetastarch excreted?

A

urine (~40%) within 24 hours

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12
Q

What are contraindications to hetastarch?

A

Severe bleeding disorders, congestive heart failure, renal failure

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13
Q

What is dextran?

A

Synthetic colloids composed of polysaccharide molecules

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14
Q

What is dextran designated by?

A

Designated by their average molecular weights:

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15
Q

What is the two difference types of dextran?

A
  • Dextran 40 MW of 40,000 kilo Dalton

- Dextran 70 MW of 70,000 kilo Dalton

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16
Q

-Dextran 40 MW of _______ Dalton

A

40,000 kilo

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17
Q

Dextran 70 MW of _________Dalton

A

70,000 kilo Dalton

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18
Q

Clearance is dependent on _____

A

Clearance is dependent on MW

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19
Q

What effective agent is dextran?

A

Effective antithrombotic agent

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20
Q

What are the effective antithrombotic agents of dextran?

A
  • Impairment of von Willebrand factor
  • Activation of plasminogen
  • Preventing platelet aggregation
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21
Q

What is the maximum dose of dextran for pt with normal hemostatic function?

A

maximum dose of 1.5-2g/kg to avoid bleeding complications

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22
Q

What is the half life of dextran?

A

roughly 6-12 hours

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23
Q

Explain the half-life of dextran.

A

Dextran particles which are too large and surpass the threshold for renal excretion are phagocytized by the reticuloendothelial system, degraded to glucose, and metabolized to carbon dioxide and water over several days

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24
Q

What can dextran interfere with?

A

Can adhere to surface of platelets and RBCs, interfering with cross matching

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25
Q

What can occur with dextran?

A

Highly allergenic leading to anaphylaxis

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26
Q

What is albumin?

A

Heat treated preparation of human serum

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27
Q

What are the different types of albumin?

A
  • 5% = 50 g/L

- 25% = 250g/L

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28
Q

Where does the albumin stay?

A

Half of infused volume will stay intravascular

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29
Q

What is colloid osmotic pressure?

A

20mmHg

30
Q

What is 25% albumin’s osmotic pressure?

A

70mmHg

31
Q

What are the characteristics of colloid osmotic pressure?

A
  • Will expand vascular space by 4-5 times the volume infused

- 25% only used in the case of hypo-albuminemia

32
Q

What is gelatins derived from?

A

Derived from hydrolyzed bovine collagen

33
Q

What is the molecular weight of gelatins?

A

Molecular weight of 30-65 kDa leads to shorter half life of ~4hrs

34
Q

Why is gelatins not available in US?

A

Highly allergenic so not available in U.S.

35
Q

What are side effects of gelatins?

A
  • Can be nephrotoxic
  • Causes histamine release (H1 blockers recommended)
  • Risk of bovine spongiform encephalopathy
36
Q

What is critical for burn victims?

A

Rapid, effective intravascular volume replenishment critical to mitigate burn shock

37
Q

What can happen if resuscitation is delayed in burn victims?

A

Delayed or inadequate resuscitation results in hypovolemia, tissue hypoperfusion, shock, multiple organ system failure

38
Q

What is the general rule for fluid resuscitation of burn victims?

A

Burns less than 15% of total body surface area can be managed with oral or IV fluid administered at 1.5 times the maintenance rate

39
Q

What is the tissue level involved in first degree (superficial burns)?

A

Epidermis

40
Q

What is the tissue level involved in superficial dermal burn?

A

epidermis and upper dermis

41
Q

What is the tissue level involved in deep dermal burn?

A

epidermis and deep dermis

42
Q

What is the tissue level involved in third degree (Full thickness) dermal burn?

A

destruction of epidermis and dermis

43
Q

What is the tissue level involved in fourth degree dermal burn?

A

skeletal muscle, fascia and bone

44
Q

Review burn differences

A

Slide 72

45
Q

What is the burn formula for adults?

A

LR 2-4mL x kg body weight x %TBSA burned

46
Q

What is the burn formula for children?

A

3-4mL x kg body weight x %TBSA burned

47
Q

What is different about infants and young childrens fluid resuscitation in burns?

A

Infants and young children should receive fluid with 5% dextrose at a maintenance rate in addition

48
Q

What is the urinary output for adults?

A

0.5-1.0mL/kg/hr

49
Q

What is the urinary output for Children weighing <30kg?

A

1mL/kg/hr

50
Q

What is the urinary output for Patient w/ high voltage electrical injuries?

A

1-1.5mL/kg/hr

51
Q

What are the two formulas for perioperative fluid management of burns?

A

Parkland and Modified Brooke formulas

52
Q

What is the recommended first line of perioperative fluid management of burns?

A

Recommends isotonic crystalloid initially

53
Q

What is the most common isotonic crystolloid used for first line of tx for burns?

A

Lactated Ringer’s solution most commonly used secondary to risk of metabolic acidosis with normal saline

54
Q

When should colloids be started in burn patients?

A

Use of colloids 24 hours after the injury

55
Q

What is the current discussion regarding colloids and burn patients?

A
  • Lack of consensus around when to start colloid therapy – many now beginning to use before 24 hours
  • E.g. 8 hours after injury if responding inadequately to crystalloid therapy
  • E.g. Pediatric patients
56
Q

What is the fluid administration in the first 24 hours according to the Modified Brooke?

A
  • 2mL LR x %TBSA burned x kg
  • Half in first 8 hours; half in next 16 hours
  • No colloid
57
Q

What is the fluid administration in the second 24 hours according to the Modified Brooke?

A

D5W maintenance and 0.5mL x %TBSA burned x kg

58
Q

What is the fluid administration in the first 24 hours according to the Parkland?

A
  • First 24 hrs: 4mL LR x %TBSA burned x kg
  • Half in first 8 hours; half in next 16 hours
  • No colloid
59
Q

What is the fluid administration in the second 24 hours according to the Parkland?

A

D5W maintenance and 0.5mL x %TBSA burned x kg

60
Q

What is the total body surface area estimated by?

A

in adults using the “rule of nines”

61
Q

What is the total body surface area estimated by for children?

A

Lund-Browder chart

62
Q

What is the Lund-Browder chart?

A

Age specific diagram that more precisely accounts for changing body surface area relationships with age

63
Q

Review rule of nines and lund browder chart.

A

Slide 77

64
Q

What is important to remember regarding the fluid management formulas?

A

Regardless of which formula is used, it should serve only as a guideline and resuscitation should be titrated to physiologic endpoints

65
Q

What can effect actual fluid requirements?

A

can vary depending on size and depth of burn, interval from injury to start of resuscitation, presence of associated injuries, and presence of inhalational injury

66
Q

What is the definition of massive blood transfusion?

A
  • Requiring 10 units of RBCs in 24 hrs

- Loss of one blood volume in a 70kg patient

67
Q

What needs to be done after receiving 6units of transfusion?

A
  • Hemoglobin and platelet counts
  • Coagulation studies (PT, PTT, INR)
  • Plasma fibrinogen concentration
  • Fibrin degradation products
  • pH from arterial blood gas analysis
  • Plasma electrolytes
68
Q

What are complications of massive blood transfusion?

A

Coagulopathy, citrate toxicity, hypothermia, acid-base imbalances, serum potassium concentration and DIC?

69
Q

What is coagulopathy associated with massive blood transfusions?

A

Secondary to dilutional thrombocytopenia and dilution of coagulation factors

70
Q

What is citrate toxicity associated with massive blood transfusions?

A

Does not occur in most patients unless transfusion rate exceeds 1 unit every 5 minutes

71
Q

What is acid-base imbalances associated with massive blood transfusions?

A

Most common abnormality after massive blood transfusion is metabolic alkalosis

72
Q

What is Serum Potassium Concentration

imbalances associated with massive blood transfusions?

A
  • Can develop regardless of the age of the blood when transfusion rates exceed 100mL/min
  • Amount of extracellular potassium transfused with each unit less than 4meq per unit

2-General Anesthesia Exam 2 (11 decks)

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