Kidney 6 Flashcards
Drugs to avoid in the patient on dialysis include: (select 2):
a. vecuronium
b. meperidine
c. succinylcholine
d. dexmedetomidine
a. vecuronium
b. meperidine
________- do not directly cause kidney dysfunction
The modern halogenated anesthetics
Although there’s no human data that links AKI and compound A, the FDA recommends that sevoflurane be administered at a rate of
1 L/min for no more than 2 MAC hours
The rate of compound A production is increased by
low FGF
high sevo vol%
warm soda lime
increased CO2 production
Succinylcholine can increase serum potassium by _________ for up to ________
0.5-1.0 mEq/L for up to 10-15 minutes
Due to their organ-independent elimination ____________ are the best nondepolarizing NMBs for renal failure.
Cisatracurium and atracurium
The following do not require dosage adjustments in patients with kidney disease
Both anticholinesterases and anticholinergics
____________ is not recommended in patients with severe renal impairment
Sugammadex
____________ may need an upward dosage adjustment due to a hyperdynamic circulation and disruption of the blood-brain barrier secondary to uremia
Propofol
Morphine is metabolized to
morphine-6-glucuronide which relies on renal excretion
Meperidine is metabolized to
nonmeperidine
Accumulation of normeperidine can cause
convulsions
Altered responses to anesthetic drugs in the setting of kidney disease are usually due to one or more of the following:
active metabolites
acidosis increases the nonionized fraction
decreased protein binding increases the free fraction
impaired elimination of active metabolites
uremia-induced disruption in the blood-brain barrier
Patients with renal failure may experience exaggerated hemodynamic effects due to:
antihypertensive medications- specifically ACEI & ARBs
attenuation of SNS tone
positive pressure ventilation
_____________ metabolism liberates a significant amount of free fluoride ions and was related to high output renal failure
methoxyflurane
All of the following reduce the incidence of contrast-induce nephropathy EXCEPT:
a. sodium bicarbonate
b. fluid bolus with 0.9% NaCl
c. low-osmolar contrast dye
d. furosemide
d. furosemide
The risk of AKI related to nephrotoxic agents is increased in patients with
pre-existing kidney disease
hypovolemia
sepsis
CHF
_________ can also cause anaphylaxis
Radiographic contrast media
Prevention of contrast-induced nephropathy includse
use nonionic, iso or low-osmolar contrast instead of hyperosmolar contrast
use the lowest volume allowed
withhold other drugs with known nephrotoxic effects
hydrate with IV 0.9% NaCl before administration of contrast dye
sodium bicarb injection or infusion
__________ is nephrotoxic and can lead to tubular obstruction and acute tubular necrosis
Myoglobin
Myoglobin is best treated with
aggressive IV hydration and an agent to alkalize the urine (e.g. sodium bicarb or acetazolamide)
Nephrotoxic antibiotics include
gentamycin
tobramycin
amikacin
vancomycin
amphotericin B
sulfonamide
tetracyclines
cephalosporins
The two ways that sevoflurane can theoretically impair renal function include
compound A (produced in the breathing circuit)
production of free fluoride ions (produced by the liver)
______________ are immunosuppressant agents that prevent the rejection of transplanted organs
Calcineurin inhibitors (cyclosporine & tacrolimus)
___________ is a non-calcineurin inhibitor that carries a much lower risk of nephrotoxicity
Sirolimus
The extent of nephrotoxic effects is determined by the
concentration of the toxin & duration of exposure
How does radiographic contrast media cause nephrotoxicity?
ischemic injury d/t vasoconstriction in the renal medulla
direct cytotoxic effects
Signs of AKI begin at
24-36 hours & peak at 3-5 days
Myoglobin is released into the circulation during
a hemolytic reaction or rhabdomyolysis
Rhabdomyolysis and myoglobinemia are sequelae of
direct muscle trauma
muscle ischemia
prolonged immobilization
MH
succinylcholine in a patient with Duchenne muscular dystrophy
A level of creatine phosphokinase above _______ is associated with an increased risk of kidney injury
10,000 units/L
Prevention strategies with myoglobin include
maintenance of renal blood flow and tubular flow with IV hydration
osmotic diuresis with mannitol
keep UOP >100-150 mL/hr
administer sodium bicarb and/or acetazolamide to alkalize the urine
The risk of AKI with aminoglycosides is reduced with
IV fluids
correction of correctable risk factors
close monitoring of serum trough levels
For the patient undergoing TURP, match each irrigation fluid with its unique anesthetic consideration
sorbitol
glycine
distilled water
normal saline
hemolysis
transient blindness
hyperglycemia
risk of electrocution
distilled water- hemolysis
sorbitol- hyperglycemia
normal saline- risk of electrocution
glycine-transient blindness
The most common approach to TURP is
neuraxial anesthesia
A level of ___ is required for TURP
T10
Neuraxial anesthesia is preferred b/c it allows for
earlier detection of complications since the patient’s neurologic status can be assessed
Risk of TURP related to continuous fluid administration include
circulatory overload & toxicity from irrigation solutes
Resection time of TURP should be limited to
1 hour
The absorbed volume can be estimated as
10-30 mL/min of resection time
Absorption of a large volume of ___________ can produce TURP syndrome
hypo-osmolar irrigation solution
The classic triad of TURP syndrome includes
hypertension
bradycardia
change in mental status
Glycine absorption can lead to
transient blindness
Treatment for transient blindness includes
no treatment is required
Treatment for TURP syndrome includes
cardiopulmonary support
correcting serum sodium levels
administering midazolam for seizures
Other complications of TURP include
bladder perforation (abdominal and shoulder pain)
bleeding
hypothermia
