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APA3 levi 2019 S.Horvath > organs > Flashcards

organs Flashcards

1
Q

What is the maximum cold ischemic time for heart and lungs

A

4-6h

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2
Q

What is the maximum cold ischemic time for liver

A

12-24h

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3
Q

What is the maximum cold ischemic time for kidney

A

72h

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4
Q

brain dead patients are hypertensive or hypotensive?

A

hypotensive

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5
Q

what causes hypovolemia in the brain dead patient

A

diabetes insipidus, hemorrhage

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6
Q

when is anesthesia support of donor systems necessary until?

A

the proximal aorta is clamped.

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7
Q

when will anesthesia support be requires post cross clamp?

A

if the lungs are to be recovered for transplantation

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8
Q

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

A

to insure that perfusion is delivered at the cellular level.

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9
Q

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

A

BP >100 systolic

CVP 8-12

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10
Q

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

A

> 96% and urine >100cc/hr

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11
Q

T/F Muscle relaxant may be required for the donor

A

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

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12
Q

T/F Limit fluids in the donor before harvesting.

A

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

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13
Q

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

A

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

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14
Q

Absolute contraindications to organ implantation:

A

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

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15
Q

4 major indictions for kidney transplantation

A

DM, hypertension induced nephropathy, glomerulonephritis, polycystic kidney disease

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16
Q

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

A

DM & HTN-induced nephropathy

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17
Q

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

A

8

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18
Q

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

A

Type 1 IDDM.

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

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19
Q

what is the lung function like in type 1 IDDM?

A

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

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20
Q

how are you gonna calculate fluids for the living donor?

A

maintain UO > 100mL/hr

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21
Q

T/F N20 is contraindicated in renal transplants.

A

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

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22
Q

which two drugs are given to continue perfusing kidney?

A

mannitol/ lasix

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23
Q

why would you need a PAC in a renal transplant case

A

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

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24
Q

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

A

perfusion pressure —- hypotension

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25
Q

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

A

alpha adrenergics

26
Q

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

A

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

27
Q

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

A

TRUE

28
Q

which drug may increase gastric emptying and LES tone

A

metoclopramide

29
Q

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

A

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

30
Q

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

A

H2 blocker

31
Q

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

A

mannitol , loop diuretics

32
Q

why is reperfusion of the kidney graft associated with hypotension

A

reduction in preload as a consequence of unclamping the iliac artery

33
Q

how should you treat hotn related to unclamping the iliac?

A

crystalloid, colloid, low-dose dopamine

34
Q

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

A

they may raise K+ levels.

give short acting anti-hypertensives

35
Q

alcoholic cirrhosis patient may be considered for transplant if……

A

abstinence of alcohol for 6 months and ongoing therapy and evaluation

36
Q

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

A

FALSE - most come from heart beating cadaveric donors.

37
Q

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

A

SVR is reduced, CI is increased

38
Q

Differential diagnosis of hepatic encephalopathy includes which other conditions?

A

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

39
Q

blood changes expected with liver failure - platelets?

A

thrombocytopenia

40
Q

blood changes expected with liver failure - PT and PTT?

A

prolonged

41
Q

blood changes expected with liver failure - fibrinogen

A

decreased plasma fibrinogen concentration

42
Q

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

A

TRUE

43
Q

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

A

FALSE - HYPOkalemia, HYPOcalcemia.

44
Q

Which acid-base imbalance is associated with liver failure

A

metabolic acidosis

45
Q

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

A

hypocalcemia, hyperkalemia, metabolic acidosis

46
Q

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

A

FALSE - impaired venous return from surgical retraction and IVC clamping

47
Q

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

A

TRUE

48
Q

The anhepatic phase begins with what part of the procedure?

A

clamping of hepatic blood flow

49
Q

What causes profound hypotension and tachycardia in the anhepatic phase?

A

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

50
Q

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

A

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

51
Q

Where do you want K levels during the neophatic phase

A

<4.5

52
Q

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

A

post reperfusion

53
Q

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

A

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

54
Q

Reperfusion syndrome - what happens to HR and BP

A

DROP

may see bradyarrythmias

55
Q

Reperfusion syndrome - what happens to PVR

A

increases

56
Q

Reperfusion syndrome - what happens to SVR

A

decreases

57
Q

Reperfusion syndrome - what happens to potassium levels

A

can see rapid increase

58
Q

Why do severe coagulopathies occur in reperfusion syndrome?

A

d/t fibrinolysis, release of heparin and hypothermia

59
Q

what are some signs of a functioning hepatic graft?

A

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

60
Q

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

A

TRUE.

61
Q

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

A

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

APA3 levi 2019 S.Horvath (16 decks)

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