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Principles2 > Organ Transplant > Flashcards

Organ Transplant Flashcards

1
Q

what 4 reversible causes of a coma must be ruled out? (H, H, T, D)

A

hypotension, hypothermia, toxins, drugs

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2
Q

can the MD involved in the transplant declare death?

A

no

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3
Q

what are 2 clinical S&S that confirm brain death? (FE, D/ASNBF)

A

flat EEG, doppler/angiography showing no blood flow

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4
Q

what drugs do you minimize the use of? (V)

A

vasopressors

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5
Q

what are the euvolemia values of these:

  1. HCT of what %?
  2. INR < what?
  3. CVP what range of mmHg?
  4. PCWP < what?
A
  1. 30%
  2. < 1.5
  3. 6-12 mmHg
  4. 12 mmHg
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6
Q

keep sodium less than what? (mEq/L)

A

150

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7
Q

adjust minute ventilation to keep PaCO2 between what range? (mmHg)

A

30-35 mmHg

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8
Q

anesthesia providers are off the case right after what is clamped? (A)

A

aorta

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9
Q

pneumoperitoneum decreased RBF so what is especially important? (N)

A

normovolemia

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10
Q

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?

A

10 mL/kg; 100 mL/hr

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11
Q

is the left or right lobe of an adult liver given to a child?

A

left

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12
Q

is the left or right lobe of an adult liver given to an adult?

A

right

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13
Q

isovolemic hemodilution may decrease the need to do what for the liver donor? (T)

A

transfuse

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14
Q

using what device can decrease the need for liver donor homologous transfusion? (C)

A

cellsaver

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15
Q

what system complication is the leading cause of death during and after a kidney transplant? (C)

A

C/V

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16
Q

what percent of kidney transplants have these diseases?

  1. DM
  2. HTN
A
  1. 26%

2. 21%

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17
Q

since the cold ischemic time for a kidney is 24-36 hours, what should be done prior to the transplant to minimize hyperkalemia? (H)

A

hemodialysis

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18
Q

what 2 vessels are the sites of the graft’s anastomoses:

  1. in adults
  2. in children
A
  1. iliac artery and vein

2. aorta, IVC

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19
Q

what are the 2 preferred muscle relaxants for pts receiving a kidney transplant?

A

atracurium, cisatracurium

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20
Q

what should these values be greater than to preserve renal BF?

  1. SBP
  2. MAP
  3. CVP
A
  1. 90
  2. 60
  3. 10
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21
Q

what can be give to pts receiving a kidney transplant to expand blood volume without impacting plt function? (LHS)

A

LMW hydroxyethyl starch

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22
Q

once the surgeon has begun the arterial and venous anastomoses, what drug should be given? (D)

A

diuretics (mannitol and/or furosemide)

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23
Q

what other 2 drugs may surgeons give at the time of arterial and venous anastomoses? (H, V)

A

heparin, verapamil

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24
Q

since the graft is unable to concentrate urine after transplant, what should be monitored? (E)

A

electrolytes

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25
Q

since the pts receiving the kidney transplant is immunosuppressed, what type of blood should they receive if they are CMV negative?

A

CMV negative blood

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26
Q

what type of drug is CI post kidney transplant? (N)

A

NSAIDs

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27
Q

should you give toradol to a pt post kidney transplant?

A

no

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28
Q

what is the most common postop kidney transplant complication? (UO)

A

ureter obstruction

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29
Q

are adults or peds more prone to thromboses post kidney transplant?

A

peds

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30
Q

pancreas transplants are usually done in conjunction with what other organ transplant?

A

kidney

31
Q

how does the glucose levels drop after the new pancreas is sewn in? R)

A

rapidly

32
Q

what are the 3 most common causes of adult ESLD? (HC, AA, AD)

A
  1. hepatitis C
  2. alcohol abuse
  3. autoimmune diseases
33
Q

what is the most common indication for a liver transplant in children? (BA)

A

biliary atresia

34
Q

what are the 4 most common postop morbidities for liver transplants? (P, B, DLF, S/PWH)

A
  1. pneumonia
  2. bleeding
  3. deteriorating liver function
  4. sepsis/poor wound healing
35
Q

the MELD or MELT formula is based on what 3 lab tests? (BIC)

A
  1. bilirubin
  2. INR
  3. Cr
36
Q

the sickest potential liver candidates are reevauluated every how many hours?

A

48 hours

37
Q

C/V changes ESLD:

  1. increased or decreased SVR?
  2. hypo or hyperdynamic circulation?
  3. what interval is prolonged?
  4. what 2 meds are the responses blunted? (I, V)
A
  1. decreased
  2. hyperdynamic
  3. QT
  4. inotropes, vasopressors
38
Q

plts should be given if they are less than how many per mm cubed?

A

70,000

39
Q

liver transplant coagulopathy:

  1. what 2 lab values guide administration of FFP and cryo?
  2. what 2 functional test of the clotting guide administration of FFP and cryo?
A
  1. INR, fibrinogen

2. TEG, ROTEM

40
Q

Liver Transplant drugs:

  1. muscle relaxants are what followed by what?
  2. what 2 types of IVFs are used?
  3. what is the concentration of epi-lite?
A
  1. succs followed by cisatracurium
  2. NS and 0.45 NS with NaHCO3
  3. 10mcg/mL
41
Q

how many each of PRBCs and FFP are ordered?

A

10 of each

42
Q

plts and cryo are usually not given during a liver transplant until after what? (R)

A

reperfusion

43
Q

most pts receiving a liver are considered a full stomach d/t what 2 things? (DGE, A)

A

delayed gastric emptying, ascites

44
Q

avoid what 2 drugs during a liver transplant because they are metabolized by the liver ? (M,M)

A

meperidine, morphine

45
Q

0.45 NaCl w 50 mEq NaHCO3 is a handy solution to give to avoid what 2 things? (ESL, H)

A
  1. excess sodium load

2. hyperchloremia

46
Q

liver pts with a hyperdynamic circulation have an increased or decreased CO and an increased or decreased SVR?

A

increased CO, decreased SVR

47
Q

liver pts pharmacology:

  1. increased or decreased albumin?
  2. increased or decreased bilirubin?
  3. increased or decreased total body water?
A
  1. decreased
  2. increased
  3. increased
48
Q

how many grams of CaCl is given per hour to avoid citrate intoxication? (g/hr, range)

A

0.5-1 g/hr

49
Q

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)

A

veno-veno bypass

50
Q

what 4 things can be give to decrease potassium levels? (I, D, N, F)

A

insulin, dextrose, NaHCO3, furosemide

51
Q

does hyper or hypoventilation decrease potassium levels?

A

hyperventilation

52
Q

why does hyperkalemia occur after the liver is put in?

A

because the solution that preserves the liver has large amounts of potassium

53
Q

what can be give to stabilize the cardiac membrane from hyperkalemia? (C)

A

CaCl

54
Q

should VA be continued during reperfusion of the graft?

A

no

55
Q

what can be given for sedation during the graft reperfusion time? (M)

A

midazolam

56
Q

what 2 vasopressors should be prepared during the reperfusion phase of the liver? (P, EL)

A

phenylephrine, epi-lite

57
Q

an early indication that the liver is working is what as the citrate found in blood products is metabolized into bicarbonate? (MA)

A

metabolic alkalosis

58
Q

other signs of graft function are an increased or decreased SVR and an increased or decreased CO as vasoactive substances are metabolized?

A

increased SVR, decreased CO

59
Q

instead of PA pressures for peds, hat is instead monitored?

A

CVP

60
Q

if the child is small and is receiving an adult liver, what system can possibly become compromised? (R)

A

respiratory

61
Q

is a hepatic artery thrombosis more common in adults or children?

A

children

62
Q

is immunosuppressive therapy more likely with kidney transplants or liver transplants?

A

kidney

63
Q

cyclosporin possibly prolongs what NMB? (P)

A

pancuronium

64
Q

is MAC increased or decreased with cyclosporin?

A

increased

65
Q

what are the 2 SEs of mycophenolate mofetil (cellcept)? (L, T)

A

leukopenia, thrombocytopenia

66
Q

what is a common SE of azathioprine? (P)

A

pancytopenia

67
Q

what can azathioprine suppress? (BM)

A

bone marrow

68
Q

is QT prolonged in ESLD pts?

A

yes

69
Q

do inotropes and vasopressors work as well in ESLD pts?

A

no

70
Q

in what phase of the liver transplant may vasopressors be needed to support the BP?

A

anhepatic

71
Q

in what phase of the liver transplant should the VAs be turned off?

A

reperfusion of the graft

72
Q

in what phase of the liver transplant should you prepare to treat hyperkalemia?

A

reperfusion of the graft

73
Q

in what phase of the liver transplant can veno-veno bypass be used to reduce portal pressure?

A

dissection

74
Q

in what phase of the liver transplant is a CaCl gtt needed to avoid citrate intoxication?

A

dissection phase

Principles2 (21 decks)

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