organs

Question 1

What is the maximum cold ischemic time for heart and lungs

Answer 1

4-6h

Question 2

What is the maximum cold ischemic time for liver

Answer 2

12-24h

Question 3

What is the maximum cold ischemic time for kidney

Answer 3

72h

Question 4

brain dead patients are hypertensive or hypotensive?

Answer 4

hypotensive

Question 5

what causes hypovolemia in the brain dead patient

Answer 5

diabetes insipidus, hemorrhage

Question 6

when is anesthesia support of donor systems necessary until?

Answer 6

the proximal aorta is clamped.

Question 7

when will anesthesia support be requires post cross clamp?

Answer 7

if the lungs are to be recovered for transplantation

Question 8

why do you need to hyperventilate the lungs before they are harvested?

Answer 8

to insure that perfusion is delivered at the cellular level.

Question 9

where do you want to keep th BP and CVP of the donor?

Answer 9

BP >100 systolic

CVP 8-12

Question 10

where do you want to keep O2 sat and urine output of the donor

Answer 10

> 96% and urine >100cc/hr

Question 11

T/F Muscle relaxant may be required for the donor

Answer 11

TRUE. may need muscle relaxant to neutralize spinal reflexes and relax the abdomen. want long acting… pavulon/vec are good choices

Question 12

T/F Limit fluids in the donor before harvesting.

Answer 12

FALSE. Vigourous volume expansion with crystalloid and colloid is usually necessary to avoid hypotension. 6-8L

Question 13

PRBC’s on hold for ____ donors. PRBC’s in the room for ____ donors.

Answer 13

renal on hold. liver in OR (2 or more units)

Question 14

Absolute contraindications to organ implantation:

Answer 14

active uncontrolled infection, AIDS, inability tolerate immune suppression, severe cardiopulmonary/medical condition. continued drug/etoh abuse, extrahepatic malignancy, inability to comply with medical regimen, lack of psychosocial support

Question 15

4 major indictions for kidney transplantation

Answer 15

DM, hypertension induced nephropathy, glomerulonephritis, polycystic kidney disease

Question 16

what are the 2 most common reasons for people to need a renal transplant?

Answer 16

DM & HTN-induced nephropathy

Question 17

a hemoglobin of __% or greater is needed for adequate O2 delivery to the heart and transplanted graft

Answer 17

8

Question 18

which disease do patients often manifest with stiff joint syndrome making airway eval extremely important?

Answer 18

Type 1 IDDM.

These patients often manifest with stiff joint syndrome characterized by a fixation of the atlantooccipital joint along with limited head extension.

Question 19

what is the lung function like in type 1 IDDM?

Answer 19

loss of elastic properties - decreased compliance - decrease in cough reactivity = restriction of lung volumes with reduced TV and FEV (forced expired ventilation)

Question 20

how are you gonna calculate fluids for the living donor?

Answer 20

maintain UO > 100mL/hr

Question 21

T/F N20 is contraindicated in renal transplants.

Answer 21

TRUE. distended bowel can get in surgeons way (laparoscopic)

Question 22

which two drugs are given to continue perfusing kidney?

Answer 22

mannitol/ lasix

Question 23

why would you need a PAC in a renal transplant case

Answer 23

to monitor CO, SVO2, and pulmonary arterial and capillary pressures

Question 24

graft function is critically dependent on ____, so you should be attentive to ____ after reperfusion

Answer 24

perfusion pressure —- hypotension

Question 25

which drugs should you avoid in the kidney patient because the transplanted kidney is sensitive to sympathomimetics?

Answer 25

alpha adrenergics

Question 26

renal transplant patient: choice of muscle relaxant depends on K+ level. In normokalemic pts, succs is safe, otherwise ____ or _____ is preferable

Answer 26

cisatracurium (0.1mg/kg) or mivacurium (.15-0.2mg/kg)

Question 27

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

Answer 27

TRUE

Question 28

which drug may increase gastric emptying and LES tone

Answer 28

metoclopramide

Question 29

if diabetic gastroparesis is a concern, _____ is administered immediately prior to the induction of anesthesia to decrease gastric acid content.

Answer 29

non-particulate antacid sodium citrate and citric acid oral solution 30mL

Question 30

If time allows, administration of ____ 6-12h prior to induction can decrease gastric acid production

Answer 30

H2 blocker

Question 31

before unclamping vascular supply to transplanted kidney, give ___ and ____

Answer 31

mannitol , loop diuretics

Question 32

why is reperfusion of the kidney graft associated with hypotension

Answer 32

reduction in preload as a consequence of unclamping the iliac artery

Question 33

how should you treat hotn related to unclamping the iliac?

Answer 33

crystalloid, colloid, low-dose dopamine

Question 34

why should you avoid long acting beta blockers for emergence in renal transplant patients?

Answer 34

they may raise K+ levels. give short acting anti-hypertensives

Question 35

alcoholic cirrhosis patient may be considered for transplant if......

Answer 35

abstinence of alcohol for 6 months and ongoing therapy and evaluation

Question 36

T/F Most livers available for transplantation come from brain dead donors.

Answer 36

FALSE - most come from heart beating cadaveric donors.

Question 37

What happens to SVR and CI with chronic liver dysfunction and cirrhosis?

Answer 37

SVR is reduced, CI is increased

Question 38

Differential diagnosis of hepatic encephalopathy includes which other conditions?

Answer 38

many other confocal neurologic conditions such as hypoglycemia, hyponatremia, intracranial hemorrgae or mass lesions, and meningitis.

Question 39

blood changes expected with liver failure - platelets?

Answer 39

thrombocytopenia

Question 40

blood changes expected with liver failure - PT and PTT?

Answer 40

prolonged

Question 41

blood changes expected with liver failure - fibrinogen

Answer 41

decreased plasma fibrinogen concentration

Question 42

T/F DIC as well as protein C/S deficiency is associated with Liver failure.

Answer 42

TRUE

Question 43

T/F Hyperkalemia and hypocalcemia are associated with liver failure.

Answer 43

FALSE - HYPOkalemia, HYPOcalcemia.

Question 44

Which acid-base imbalance is associated with liver failure

Answer 44

metabolic acidosis

Question 45

Preanhepatic phase is associated with ___calcemia , ____kalemia, and metabolic _____

Answer 45

hypocalcemia, hyperkalemia, metabolic acidosis

Question 46

T/F Expect preload and CVP to be elevated during the preanhepatic phase.

Answer 46

FALSE - impaired venous return from surgical retraction and IVC clamping

Question 47

T/F Hemorrhage and coagulation problems are both concerning in the preanhepatic phase.

Answer 47

TRUE

Question 48

The anhepatic phase begins with what part of the procedure?

Answer 48

clamping of hepatic blood flow

Question 49

What causes profound hypotension and tachycardia in the anhepatic phase?

Answer 49

the bicaval clamp - clamps vena cava above and below liver. this drops preload, causing profound hypotension and tachycardia.

Question 50

During which phase should you be concerned about citrate intoxication and why?

Answer 50

during the anhepatic phase because of rapid infusion of large volumes of blood in absence of liver function

Question 51

Where do you want K levels during the neophatic phase

Answer 51

<4.5

Question 52

severe hemodynamic instability may occur with unclamping of portal vein - also called _____ syndrome

Answer 52

post reperfusion

Question 53

T/F You should load the patient with fluids prior to unclamping.

Answer 53

FALSE - fluid overload prior to unclamping should be avoided. but you may need potent vasopressors- epi, norepinephrine, both.

Question 54

Reperfusion syndrome - what happens to HR and BP

Answer 54

DROP | may see bradyarrythmias

Question 55

Reperfusion syndrome - what happens to PVR

Answer 55

increases

Question 56

Reperfusion syndrome - what happens to SVR

Answer 56

decreases

Question 57

Reperfusion syndrome - what happens to potassium levels

Answer 57

can see rapid increase

Question 58

Why do severe coagulopathies occur in reperfusion syndrome?

Answer 58

d/t fibrinolysis, release of heparin and hypothermia

Question 59

what are some signs of a functioning hepatic graft?

Answer 59

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

Question 60

T/F As a consequence of denervation, the transplanted heart has no sensory, sympathetic, and parasympathetic innervations

Answer 60

TRUE.

Question 61

Should the HR be kept high or low post heart transplant?

Answer 61

high, 90-110's because the parasympathetic innervation that normally lowers the HR is not present.