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Advanced Anesthesia 2 > Organ Donation & Transplant - Quiz 2 > Flashcards

Organ Donation & Transplant - Quiz 2 Flashcards

1
Q

What is the Max Cold Ischemic Time for Heart & Lungs?

A

4 - 6 hrs.

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2
Q

What is the Max Cold Ischemic Time for Livers?

A

12 - 24 hrs.

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3
Q

What is the Max Cold Ischemic Time for Kidneys?

A

72 hrs

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4
Q

How is Death defined?

A

Irreversible cessation of circulatory, respiratory, or all functions of entire brain

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5
Q

The Organ Donor designation on a driver’s license is ______ and ______ require family persmission

A

The Organ Donor designation on a driver’s license is LEGALLY BINDING and DOES NOT require family persmission

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6
Q

What are the criteria for diagnosing Brain Death?

A

Loss of Cerebral Fxn

Loss of Brainstem Fx

Supporting Documentation (EEG, CBF)

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7
Q

What are common physiological changes after Brain Death?

A

Hypotension

Arterial Hypoxemia

Hypothermia

Arrhythmias

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8
Q

When is anesthesia needed for Organ Procurement?

A

Anesthesia is absolutely required for Donation after Brain Death (DBD), but NOT for Donation after Cardiac Death (DCD)

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9
Q

When is anesthesia no longer needed for organ recovery?

A

After clamping of Proximal Aorta, unless lungs are gonna be harvested and needs Hyperventilation & Extubation

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10
Q

What inidicates adequate perfusion to maintain Viable Organs?

A

SBP > 100

CVP: 8 - 12

O2 Sat > 96%

Urine Output > 100cc/hr

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11
Q

Organ Donors should have no past medical history of what?

A

HTN

DM

Cancer

Kidney Disease

Heart Disease

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12
Q

Which muscle relaxants are frequently used for Organ Recovery?

A

Pancuronium & Vecuronium

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13
Q

What has improved the success of organ transplants?

A

Cyclosporine

Azathioprine

OKT3

Steroids

Donor:Recipient Typing

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14
Q

What are the Major indications for Kidney Transplant?

A

DM

HTN-induced Nephropathy

Glomerulonephritis

Polycystic Kidney Disease

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15
Q

What is included in the Pre-Op eval for Kidney Transplants?

A

Cardiac Risks

Volume Status

Hgb: 8 or above

Fix Lytes

Gastroparesis & Aspiration Risks

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16
Q

What is a critical pre-op evaluation for patients w/ DM1 undergoing Kidney Transplant?

A

Airway Evaluation & PFTs

They are stiff and have limited CROM

17
Q

Why should N2O be avoided for Kidney Transplants?

A

Expands bowel and gets in the way

18
Q

Avoid _______ drugs because transplanted kidney is senstive to sympathomimetics and blood flow to the organ can be compromised

A

Avoid ALPHA ADRNERGIC drugs because transplanted kidney is senstive to sympathomimetics and blood flow to the organ can be compromised

19
Q

Which NMB should be used for Kidney Transplants?

A

Succinylcholine if K+ is Normal

otherwise, Cisatacurium or Mivacurium

20
Q

What can be given as a prophylaxis for diabetic gastroparesis regarding Kidney Transplants?

A

Sodium Citrate

Citric Acid

Reglan

H2 Blockers 6-12 hrs before induction

21
Q

When should Diuretics be given to maintain Renal Perfusion & Enhance Urine Production?

A

Before unclamping vascular supply to Transplanted Kidney

22
Q

How should Hypotension be managed during Reperfusion of the Kidney Graft?

A

Crystalloid

Colloid

Low-Dose Dopamine

23
Q

What should be given for HYPERtension during Emergence for Kidney Transplant surrgery?

A

Short-Acting Anti-Hypertensives

&

AVOID Long-Acting B-Blockers to prevent K+ Increase

24
Q

How do patients w/ Chronic Liver Dysfunction present regarding CV?

A

Hyperdynamic Circulation

Low PVR

Increased Cardiac Index

25
Q

What is a major pre-op eval for Liver Transplant?

A

Cardiac Function & Ischemic Potential

26
Q

What happens during the Pre-Anhepatic Phase?

A

Lysis of Adhesion

Liver Mobilization

Hepatic Artery, CBD, Supra & Infra Vena Cava, Portal Vein Dissection

Possible Shunting Procedure to redirect Venous flow into Venous Circ.

27
Q

What are the anesthetic considerations for the Pre-Anhepatic Phase?

A

Hemorrhage & CV Instability

Coagulopathy

Impaired Venous Return from IVC Clamping

HYPOcalcemia

HYPERkalemia

Metabolic Acidosis

28
Q

What happens in the Anhepatic Phase?

A
  1. Clamping of Hepatic Blood Flow
    1. Bicaval Clamp – ↓Preload, Profound Hypotension & Tachycardia
    2. Piggyback Clamp – IVC Side-clamp – preserves some caval flow & preload
    3. Venovenous Bypass – rarely used
  2. Remove Liver including Vena Cava
  3. New Liver Implant & Flush w/ Fluid or Colloid
29
Q

What are the anesthetic considerations during the Anhepatic Phase?

A

Hemorrhage

Coagulopathy

HYPOthermia

↓Renal Function

Inotrope & Pressor Support

Citrate Intoxication

HYPOcalcemia

30
Q

What happens during the Neohepatic Phase?

A

Reperfusion - Unclamping of Portal Vein, Hepatic Artery, & Vena Cava

Hypodynamic Instability

31
Q

What are the anesthetic considerations for the Neohepatic Phase?

A

Correct Lytes

Keep K+ < 4.5

Epi & Levo Support

AVOID Fluid bolus before Unclamping

Reperfusion Syndrome

32
Q

What is Reperfusion Syndrome?

A

↓CO, HR, & BP

Brady-Arrythmias

Rapid K+ Increase

Severe Coagulopathy

HYPOthermia

33
Q

What are some early signs of a functioning Liver Graft?

A

Intra-Op Bile Production

Intra-Op Negative Base Excess Correction

Improved Coagulation

34
Q

What Post-Op complication from Liver Transplant may require Re-transplantation?

A

Thrombosis of Hepatic Artery & Portain Vein

35
Q

What is Eisenmenger’s Syndrome?

A

Extremely High PAP causing oxygen-poor blood to flow from right to left ventricle

36
Q

What is important aspect of a Post-Heart Transplant regarding catecholamines?

A

Denervation leading to no sensory, sympathetic, and parasympathetic innervations

Advanced Anesthesia 2 (8 decks)

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