Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

KLowe-Advanced Anes 2 (Rachel's Class) > Organ Donation/Transplant > Flashcards

Organ Donation/Transplant Flashcards

1
Q

Max cold ischemic times–heart and lungs = ___-___ hours; liver = ___-___ hours; kidneys = ___ hours

A

Heart and lungs = 4-6 hours; liver = 12-24 hours; kidneys = 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are (3) types of organ donors?

A
  • Brain death donors
  • Donation after cardiac death (DCD)
  • Living donors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What law is this describing?–defines death as the “irreversible cessation of circulatory and respiratory functions, or of all functions of the entire brain, including the brain stem”

A

US Uniform Determination of Death Act (1980)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

An individual’s signature on a driver’s license or donor card indicating their desire to donate their organs is legally binding and does not require family permission–T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the criteria for the diagnosis of brain death?

A
  • Loss of cerebral cortical function
  • Loss of brainstem function
  • Supporting documentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Criteria for the Diagnosis of Brain Death–loss of cerebral cortical function = no ___, unresponsive to ___

A

Loss of cerebral cortical function = no spontaneous movement, unresponsive to external stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Criteria for the Diagnosis of Brain Death–loss of brainstem function = ___, absent ___ reflexes

A

Loss of brainstem function = apnea, absent cranial nerve reflexes (papillary, corneal, oculocephalic, oculovestibular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Criteria for the Diagnosis of Brain Death–supporting documentation = ___, ___ studies

A

Supporting documentation = EEG, cerebral blood flow studies (angiography, transcranial doppler, xenon scan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Common physiologic derangements after brain death include ___tension, arterial ___emia, ___thermia, and cardiac ___

A

Common physiologic derangements after brain death include hypotension, arterial hypoxemia, hypothermia, and cardiac dysrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is donation after cardiac death?–non-___ donors; severe ___ dysfunction; have ___ activity in the brain; death is defined by cessation of ___ and ___

A
  • Non-heart-beating donors
  • Severe whole brain dysfunction
  • Have electrical activity in the brain
  • Death is defined by cessation of circulation and respiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

For donation after cardiac death, life support measures are used to control the timing of death, organ procurement, and to maximize function of organs from these donors–T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DCD donors meet the criteria for brain death–T/F?

A

False–DCD donors do NOT meet the complete criteria for brain death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

For DCD, after the patient’s heart stops beating and the physician declares death, the transplant team waits no less than ___ minutes following pulselessness before starting organ recovery

A

The transplant team waits no less than 5 minutes following pulselessness before starting organ recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anesthesia management ___ (is/is not) required for organ donation after brain death (DBD)

A

Anesthesia management IS required for organ donation after brain death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anesthesia management ___ (is/is not) required for organ donation after cardiac death (DCD)

A

Anesthesia management IS NOT required for organ donation after cardiac death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Anesthesia for organ recovery–anesthesia support of donor organ systems is necessary until the ___

A

until the proximal aorta is clamped (after which the ventilator, IVs, and cardiac monitors may be discontinued)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Anesthesia for organ recovery–if the lungs are to be recovered for transplantation, anesthesia support ___ (will/will not) be required post cross-clamp

A

if the lungs are to be recovered for transplantation, anesthesia support will be required post cross-clamp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is anesthesia needed post cross-clamp if the lungs are to be recovered?

A

Anesthesia will hyperventilate the lungs to ensure that the perfusion is delivered at the cellular level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Anesthesia for organ recovery–goal is SBP > ___; CVP ___-___; O2 sat > ___%; urine output > ___cc/hr

A

goal is SBP > 100; CVP 8-12; O2 sat > 96%; urine output > 100 cc/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Anesthesia is required for organ recovery–T/F?

A

FALSE–no anesthesia is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What might be needed to neutralize spinal reflexes and relax the abdomen during organ recovery surgery?

A

Muscle relaxant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Living organ donors are frequently related to the recipient, healthy individual between ___-___

A

18-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Living organ donors must have no history of what (5) things?

A
  • HTN
  • Diabetes
  • Cancer
  • Kidney disease
  • Heart disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Absolute contraindications to organ implantation–active uncontrolled ___; ___; inability to tolerate ___ suppression; severe ___/___ condition (pt unfit for surgery); continued ___ or ___ abuse; ___ malignancy; inability to comply with ___ regimen; lack of ___ support

A

active uncontrolled infection; AIDS; inability to tolerate immune suppression; severe cardiopulmonary/medical condition (pt unfit for surgery); continued drug or alcohol abuse; extrahepatic malignancy; inability to comply with medical regimen; lack of psychosocial support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

There has been a dramatic increase in the success of organ transplantation–T/F?

A

True

D/t immunosuppressive regimens and improved donor:recipient tissue typing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the most frequent solid organ transplant (order from greatest to least)?

A

Kidney > Liver > Heart > Lung > Heart/Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are (4) major indications for kidney transplantation?

A
  • Diabetes mellitus
  • Hypertension-induced nephropathy
  • Glomerulonephritis
  • Polycystic kidney disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are (2) most common causes of ESRD?

A
  • HTN

- DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Patients receiving kidney transplant must have cardiac workup preoperatively–T/F
?

A

True–need EKG, Holter monitor, stress test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Diabetic autonomic neuropathy can make intraoperative ___ control difficult

A

BP control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Gastroparesis, another complication of autonomic neuropathy, increases the risk of ___ during induction of GETA

A

increases the risk of aspiration during induction of GETA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

CRF is characterized by Hgb ___-___; Hgb of ___% or greater is needed for adequate O2 delivery to the heart and transplanted graft

A

CRF is characterized by Hgb 6-8%; Hgb of 8% or greater is needed for adequate O2 delivery to the heart and transplanted graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

In pts receiving hemodialysis or peritoneal dialysis, it is important to evaluate their ___, ___, and ___ status

A

acid-base, electrolyte, and volume status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

___ evaluation is very important for patients with type 1 insulin dependent diabetes mellitus (IDDM); why?

A

Airway evaluation because these patients often manifest with stiff joint syndrome, characterized by a fixation of the AO joint, along with limited head extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is another problem in patients with type 1 IDDM?–impairment of ___ function r/t loss of lung ___ properties

A

impairment of pulmonary function

36
Q

Pulmonary function impairment (for patients with type 1 IDDM) is characterized by a decrease in ___ reactivity, a significant restriction of lung volumes, with reduced ___ volume and forced ___ ventilation

A

Pulmonary function impairment (for patients with type 1 IDDM) is characterized by a decrease in cough reactivity, a significant restriction of lung volumes, with reduced tidal volume and forced expired ventilation

37
Q

Fluid protocol for living kidney donor–___ ml/kg/hr above calculated losses; maintain UO > ___ ml/hr

A

10 ml/kg/hr above calculated losses; maintain UO > 100 ml/hr

38
Q

What gas should NOT be used for living kidney donors? Why?

A

Nitrous oxide–can distend the bowel which can get in surgeons way (because it is done laparoscopically)

39
Q

What (2) vessels are identified during cadaveric kidney transplantation?

A

External iliac vein and artery

40
Q

Which is clamped/anastomosed first–the external iliac vein or artery?

A

External iliac vein is clamped/anastomosed first

41
Q

What med(s) should be given when the clamps are released from the external iliac vein/artery?

A

Mannitol or lasix

42
Q

Be attentive to ___tension after reperfusion of donor kidney because graft function is critically dependent on ___

A

Be attentive to hypotension after reperfusion of donor kidney because graft function is critically dependent on perfusion pressure

43
Q

What drugs should be avoided in kidney transplant patients? Why?

A

Avoid alpha adrenergic drugs b/c transplanted kidney is sensitive to sympathomimetics

44
Q

Alpha adrenergic drugs enhance blood flow to transplanted organs–T/F?

A

FALSE–alpha adrenergic drugs compromise blood flow to transplanted organs

45
Q

Choice of muscle relaxant in kidney transplant patients depends on what electrolyte?

A

K+ level

46
Q

In normokalemic patients, ___ (what muscle relaxant?) is safe

A

Succs– 1-1.5 mg/kg

47
Q

What are (2) other muscle relaxants that can be used in kidney transplant patients?

A
  • Cisatracurium (Hoffman elimination) (0.1 mg/kg)

- Mivacurium (0.15-0.2 mg/kg)

48
Q

___ (depolarizing/nondepolarizing) muscle relaxant is preferred in patients who are at high risk of pulmonary aspiration in ESRD d/t autonomic gastropathy, obesity, or on peritoneal dialysis with significant volume of dialysate fluid left in

A

Depolarizing–succs

49
Q

Reversal of muscle relaxants with neostigmine and robinul is safe in patients with ESRD–T/F?

A

True–but sugammadex is even better

50
Q

If diabetic gastroparesis is a concern, what can be administered immediately prior to the induction of anesthesia to decrease the gastric acid content?

A

Sodium citrate/citric acid oral solution

51
Q

What drug can be given to increase gastric emptying and lower esophageal sphincter tone?

A

Metoclopramide

52
Q

What drug can be given 6-12 hours prior to induction to decrease gastric acid production?

A

H2 blocker

53
Q

Anesthetic goals for kidney transplant = maintain renal ___ and enhance ___ production

A

maintain renal perfusion pressure and enhance urine production

54
Q

What (2) drugs should be given before unclamping vascular supply to transplanted kidney?

A
  • Mannitol

- Loop diuretics

55
Q

Reperfusion of kidney graft may be associated with ___tension; this is most often related to a reduction in the ___load as a consequence of unclamping the ___; how should you treat?

A

Reperfusion of kidney graft may be associated with hypotension; this is most often related to a reduction in the preload as a consequence of unclamping the iliac artery; treat with crystalloid, colloid, or low-dose dopamine

56
Q

Moderate to severe ___tension may accompany emergence from anesthesia for renal transplant; treat with ___ (short/long) acting antihypertensives

A

hypertension; treat with short acting antihypertensives

57
Q

Should long acting beta-blockers be used to treat hypertension on emergence from anesthesia for renal transplant?

A

NO–because they can raise K+ levels

Use short-acting antihypertensives

58
Q

How is the excretion of drugs affected by a prior renal transplant?

A

Renal excretion of drugs is usually decreased in patients with a prior renal transplant

59
Q

Most livers available for transplantation come from heart-beating cadaveric donors–T/F?

A

True

60
Q

Patients with chronic liver dysfunction and cirrhosis have a ___ (hyper/hypo) dynamic circulation with ___ (low/high) peripheral vascular resistance and a/an ___ (increased/decreased) cardiac index

A

Patients with chronic liver dysfunction and cirrhosis have a hyperdynamic circulation with low peripheral vascular resistance and an increased cardiac index

61
Q

What are the (3) phases of liver transplantation surgery?

A
  • Preanhepatic phase
  • Anhepatic phase
  • Neohepatic phase
62
Q

Preanhepatic phase involves what?

A
  • Lysis of adhesions and exploration of abdomen
  • Mobilization of liver and careful dissection of hepatic artery, common bile duct, supra and infra hepatic vena cava and portal vein
63
Q

Preanhepatic phase–if portal HTN is severe to the degree that mobilizing the liver may result in significant blood loss or the patient is unstable, then what (2) things may be instituted?

A
  • Portocaval shunt

- Venous bypass

64
Q

Preanhepatic phase–non-shunting procedures are aimed at controlling ___ from ___

A

non-shunting procedures are aimed at controlling hemorrhage from portosystemic varices

65
Q

Preanhepatic phase–shunting procedures redirect the portal venous flow into the systemic ___ circulation via a ___ conduit, thus relieving ___, decompressing ___, and at the same time relieving ___

A

shunting procedures redirect the portal venous flow into the systemic venous circulation via a nonvariceal conduit, thus relieving portal hypertension, decompressing varices, and at the same time relieving ascites

66
Q

Anesthesia management of preanhepatic phase–hemorrhage leads to ___ instability; ___ problems occur at this stage; impaired ___ from surgical retraction and IVC clamping; ___calcemia, ___kalemia, and metabolic ___osis

A

hemorrhage leads to CV instability; coagulation problems occur at this stage; impaired venous return from surgical retraction and IVC clamping; hypocalcemia, hyperkalemia, and metabolic acidosis

67
Q

Anhepatic phase begins with ___

A

clamping of hepatic blood flow

68
Q

What (2) big things occur during anhepatic phase?

A

removal of native liver, implantation of donor liver

69
Q

Bicaval clamp used during the anhepatic phase clamps what?

A

Clamps vena cava above and below the liver

70
Q

Bicaval clamp drops ___, leading to profound ___tension and ___cardia

A

Bicaval clamp drops preload, leading to profound hypotension and tachycardia

71
Q

Piggyback technique for anhepatic phase ___ clamps the IVC; what is the benefit of this?

A

Piggyback technique for anhepatic phase side clamps the IVC; benefit is that it preserves some caval flow/preload

72
Q

Venovenous bypass is not typically used today during the anhepatic phase–T/F?

A

True

Bicaval clamp or piggyback technique are typically done

73
Q

Considerations during anhepatic phase–___, increasing ___lysis, ___pathy, ___osis, ___thermia, and decreased ___ function

A

hemorrhage, increasing fibrinolysis, coagulopathy, acidosis, hypothermia, and decreased renal function

74
Q

Anhepatic phase–cardiac output and systemic blood pressure may need to be supported with ___ and ___

A

inotropes and vasopressors

75
Q

Anhepatic phase–___ intoxication may occur from rapid infusion of large volumes of blood in absence of liver function

A

citrate intoxication

76
Q

What electrolyte abnormality may occur during anhepatic phase? How should you treat?

A

Hypocalcemia–give calcium

77
Q

Neohepatic phase begins with what?

A

Unclamping of the portal vein, hepatic artery, vena cava and reperfusion of the donor liver

78
Q

What may occur with unclamping of portal vein?

A

Severe hemodynamic instability–post reperfusion syndrome

79
Q

Neohepatic phase–before unclamping of portal vein, ___ should be normal, ___ should be corrected, and K+ should be ___

A

ionized calcium should be normal, acidosis should be corrected, and K+ should be < 4.5

80
Q

What vasopressors should be used during neohepatic phase? What should be avoided?

A

Epi, norepi, or both

Avoid fluid overload prior to unclamping

81
Q

Neohepatic phase–hemodynamics typically stabilize once ___

A

allograft begins to function

82
Q

Reperfusion syndrome is characterized by decreased ___, ___, and ___; ___ defects (___arrhythmias, ___); ___ HTN; ___ (increased/decreased) SVR

A

decreased CO, HR, and BP; conduction defects (bradyarrhythmias, asystole); pulmonary HTN; decreased SVR

83
Q

Reperfusion syndrome–a rapid increase in ___ can occur, ensure normal pH and electrolytes prior to unclamping

A

a rapid increase in K+

84
Q

Reperfusion syndrome–severe coagulopathies occur d/t ___lysis, release of ___, and ___thermia

A

severe coagulopathies occur d/t fibrinolysis, release of heparin, and hypothermia

85
Q

Initial indirect signs of a functioning graft = intraoperative ___ production; intraoperative spontaneous correction of ___; improvement in ___

A

intraoperative bile production; intraoperative spontaneous correction of negative base excess; improvement in coagulation

KLowe-Advanced Anes 2 (Rachel's Class) (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions