Organ Transplant Flashcards
what 4 reversible causes of a coma must be ruled out? (H, H, T, D)
hypotension, hypothermia, toxins, drugs
can the MD involved in the transplant declare death?
no
what are 2 clinical S&S that confirm brain death? (FE, D/ASNBF)
flat EEG, doppler/angiography showing no blood flow
what drugs do you minimize the use of? (V)
vasopressors
what are the euvolemia values of these:
- HCT of what %?
- INR < what?
- CVP what range of mmHg?
- PCWP < what?
- 30%
- < 1.5
- 6-12 mmHg
- 12 mmHg
keep sodium less than what? (mEq/L)
150
adjust minute ventilation to keep PaCO2 between what range? (mmHg)
30-35 mmHg
anesthesia providers are off the case right after what is clamped? (A)
aorta
pneumoperitoneum decreased RBF so what is especially important? (N)
normovolemia
intraop management goals for living kidney donors:
as much as how many mL/kg over usual IV crystalloid calculated requirements to maintain UO of what mL/hr?
10 mL/kg; 100 mL/hr
is the left or right lobe of an adult liver given to a child?
left
is the left or right lobe of an adult liver given to an adult?
right
isovolemic hemodilution may decrease the need to do what for the liver donor? (T)
transfuse
using what device can decrease the need for liver donor homologous transfusion? (C)
cellsaver
what system complication is the leading cause of death during and after a kidney transplant? (C)
C/V
what percent of kidney transplants have these diseases?
- DM
- HTN
- 26%
2. 21%
since the cold ischemic time for a kidney is 24-36 hours, what should be done prior to the transplant to minimize hyperkalemia? (H)
hemodialysis
what 2 vessels are the sites of the graft’s anastomoses:
- in adults
- in children
- iliac artery and vein
2. aorta, IVC
what are the 2 preferred muscle relaxants for pts receiving a kidney transplant?
atracurium, cisatracurium
what should these values be greater than to preserve renal BF?
- SBP
- MAP
- CVP
- 90
- 60
- 10
what can be give to pts receiving a kidney transplant to expand blood volume without impacting plt function? (LHS)
LMW hydroxyethyl starch
once the surgeon has begun the arterial and venous anastomoses, what drug should be given? (D)
diuretics (mannitol and/or furosemide)
what other 2 drugs may surgeons give at the time of arterial and venous anastomoses? (H, V)
heparin, verapamil
since the graft is unable to concentrate urine after transplant, what should be monitored? (E)
electrolytes
since the pts receiving the kidney transplant is immunosuppressed, what type of blood should they receive if they are CMV negative?
CMV negative blood
what type of drug is CI post kidney transplant? (N)
NSAIDs
should you give toradol to a pt post kidney transplant?
no
what is the most common postop kidney transplant complication? (UO)
ureter obstruction
are adults or peds more prone to thromboses post kidney transplant?
peds
pancreas transplants are usually done in conjunction with what other organ transplant?
kidney
how does the glucose levels drop after the new pancreas is sewn in? R)
rapidly
what are the 3 most common causes of adult ESLD? (HC, AA, AD)
- hepatitis C
- alcohol abuse
- autoimmune diseases
what is the most common indication for a liver transplant in children? (BA)
biliary atresia
what are the 4 most common postop morbidities for liver transplants? (P, B, DLF, S/PWH)
- pneumonia
- bleeding
- deteriorating liver function
- sepsis/poor wound healing
the MELD or MELT formula is based on what 3 lab tests? (BIC)
- bilirubin
- INR
- Cr
the sickest potential liver candidates are reevauluated every how many hours?
48 hours
C/V changes ESLD:
- increased or decreased SVR?
- hypo or hyperdynamic circulation?
- what interval is prolonged?
- what 2 meds are the responses blunted? (I, V)
- decreased
- hyperdynamic
- QT
- inotropes, vasopressors
plts should be given if they are less than how many per mm cubed?
70,000
liver transplant coagulopathy:
- what 2 lab values guide administration of FFP and cryo?
- what 2 functional test of the clotting guide administration of FFP and cryo?
- INR, fibrinogen
2. TEG, ROTEM
Liver Transplant drugs:
- muscle relaxants are what followed by what?
- what 2 types of IVFs are used?
- what is the concentration of epi-lite?
- succs followed by cisatracurium
- NS and 0.45 NS with NaHCO3
- 10mcg/mL
how many each of PRBCs and FFP are ordered?
10 of each
plts and cryo are usually not given during a liver transplant until after what? (R)
reperfusion
most pts receiving a liver are considered a full stomach d/t what 2 things? (DGE, A)
delayed gastric emptying, ascites
avoid what 2 drugs during a liver transplant because they are metabolized by the liver ? (M,M)
meperidine, morphine
0.45 NaCl w 50 mEq NaHCO3 is a handy solution to give to avoid what 2 things? (ESL, H)
- excess sodium load
2. hyperchloremia
liver pts with a hyperdynamic circulation have an increased or decreased CO and an increased or decreased SVR?
increased CO, decreased SVR
liver pts pharmacology:
- increased or decreased albumin?
- increased or decreased bilirubin?
- increased or decreased total body water?
- decreased
- increased
- increased
how many grams of CaCl is given per hour to avoid citrate intoxication? (g/hr, range)
0.5-1 g/hr
what can be used to facilitate the dissection phase by reducing portal pressure and also improves BP when the vena cava is clamped by improving venous return? (VVB)
veno-veno bypass
what 4 things can be give to decrease potassium levels? (I, D, N, F)
insulin, dextrose, NaHCO3, furosemide
does hyper or hypoventilation decrease potassium levels?
hyperventilation
why does hyperkalemia occur after the liver is put in?
because the solution that preserves the liver has large amounts of potassium
what can be give to stabilize the cardiac membrane from hyperkalemia? (C)
CaCl
should VA be continued during reperfusion of the graft?
no
what can be given for sedation during the graft reperfusion time? (M)
midazolam
what 2 vasopressors should be prepared during the reperfusion phase of the liver? (P, EL)
phenylephrine, epi-lite
an early indication that the liver is working is what as the citrate found in blood products is metabolized into bicarbonate? (MA)
metabolic alkalosis
other signs of graft function are an increased or decreased SVR and an increased or decreased CO as vasoactive substances are metabolized?
increased SVR, decreased CO
instead of PA pressures for peds, hat is instead monitored?
CVP
if the child is small and is receiving an adult liver, what system can possibly become compromised? (R)
respiratory
is a hepatic artery thrombosis more common in adults or children?
children
is immunosuppressive therapy more likely with kidney transplants or liver transplants?
kidney
cyclosporin possibly prolongs what NMB? (P)
pancuronium
is MAC increased or decreased with cyclosporin?
increased
what are the 2 SEs of mycophenolate mofetil (cellcept)? (L, T)
leukopenia, thrombocytopenia
what is a common SE of azathioprine? (P)
pancytopenia
what can azathioprine suppress? (BM)
bone marrow
is QT prolonged in ESLD pts?
yes
do inotropes and vasopressors work as well in ESLD pts?
no
in what phase of the liver transplant may vasopressors be needed to support the BP?
anhepatic
in what phase of the liver transplant should the VAs be turned off?
reperfusion of the graft
in what phase of the liver transplant should you prepare to treat hyperkalemia?
reperfusion of the graft
in what phase of the liver transplant can veno-veno bypass be used to reduce portal pressure?
dissection
in what phase of the liver transplant is a CaCl gtt needed to avoid citrate intoxication?
dissection phase
