Renal

Question 1

Aldosterone does what with Na?

Answer 1

increased Na reabsorption

Question 2

______________ causes increased H2O reabsorption in the collecting duct

Answer 2

Vasopressin

Question 3

Reduced SNS and _____________ release enhances vasodilation and filtered Na with Hypervolemia

Answer 3

angiotensin II

Question 4

Normal auto-regulation of RBF and GFR is between _____-_____mmHg

Answer 4

80-180

Question 5

Any decrease in RBF causes a release of _____________ which will cause renal vasoconstriction

Answer 5

Renin

Question 6

Why should Tordal not be used in patients with renal disease?

Answer 6

It will inhibit the prostaglandin production via enzymes phospolipase A2 & cyclooxygenase and leave the kidney more prone to ischemic damage

Question 7

________________ oppose the actions of angiotensin II, SNS, ADH to balance a decrease in RBF produced by physiological stress and increase UO

Answer 7

prostaglandins

Question 8

__________ has inotropic effects with diuretic activity.

Answer 8

Dopamine

Question 9

Dopamine can be used at doses of ________________ for renal protection

Answer 9

1-2mcg/kg/min

Question 10

Why would you avoid spinal/ epidural anesthesia in a renal pt?

Answer 10

If they are in full renal failure and can’t receive fluid boluses to help with blood pressure drop and depend on RBF for function.

Question 11

A ____-_____ sympathectomy will decrease release of catecholamines, renin, and vasopressin

Answer 11

T4 – T10

Question 12

The concern with volatile agents and renal function is due to the production of ______________.

Answer 12

Free Flouride Ions

Question 13

The most renally toxic to least (5) are:

Answer 13

Enflurane>sevo>Iso>Des>Halothane

Question 14

Sevoflurane produces _______________ and you should do what to prevent renal injury?

Answer 14

Compound A

increase FGF >2L

Question 15

What effect does positive pressure ventilation have on RBF?

Answer 15

The greater the PIP & PEEP, the greater the decrease in RBF, GFR, and UO

Question 16

How do you overcome the changes on RBF during Positive Pressure Ventilation?

Answer 16

Give hydration to increase the preload

Question 17

What is the definition of preoperative oliguira?

Answer 17

UO

Question 18

Pre-renal causes of oliguria are:

Answer 18

Hypovolemia

Decreased CO

Question 19

Renal causes of periop oliguria include:

Answer 19

Acute Tubuluar Necrosis: renal ischemia, nephrotoxic drugs, Release of Hbg or myoglobin (MH, transfusion reaction, ect)

Question 20

Careful with Halothane and renal failure b/c……

Answer 20

Renal failure pt’s usually have higher K+’s and Halothane causes cardiac irritability

Question 21

2 drugs that are absolutely contraindicated bc they are eliminated by the kidney unchanged are:

Answer 21

gallamine and phenobarbital

Question 22

Renal pt’s will often need more or less in terms of dosing?

Answer 22

less - d/t anemia and decreased plasma proteins

Question 23

The best opioid to use in Renal failure is:

Answer 23

fentanyl

Question 24

The opioid that MUST be avoided in renal failure is:

Answer 24

Meperidine (normeperidine metabolite)

Question 25

_____________ & ______________ are opioids with active metabolites that you'll only give 1 time doses to pt's in renal failure

Answer 25

Morphine and Hydromorphone

Question 26

Which induction medications are highly protein bound and therefore RF pt's will require a lower dose with?

Answer 26

Thiopental, Dexmedetomidine, Midazolam

Question 27

Which 3 muscle relaxants must you avoid in RF?

Answer 27

D-tubocurarine, metocurine, gallamine

Question 28

Which 3 muscle relaxants do you probably want to avoid in RF?

Answer 28

Pancuronium, Pipecurium, doxacurium

Question 29

Which 2 muscle relaxants are okay to give in single doses to pt's in RF?

Answer 29

Vecuronium & Rocuronium

Question 30

Which 3 muscle relaxants are most appropriate for RF patients?

Answer 30

cisatracurium, atracurium, mivacurium

Question 31

What are you concerned about with Sch and RF patients?

Answer 31

caution with K+, single dose OKAY if K+ is normal. Has active metabolite, succinylmonocholine

Question 32

______________ is the most common cause of death in RF patients

Answer 32

infection

Question 33

Your patient in RF requires atropine and or glycopyrrolate, what should you do?

Answer 33

Decrease dose d/t potential for accumulation

Question 34

Anesthetic considerations with scopolamine and RF?

Answer 34

DO NOT give it d/t CNS effects

Question 35

H2 blockers and RF?

Answer 35

Do not give reglan, it will accumulate. H2 blockers are highly dependent on renal excretion

Question 36

Which induction drug is the safest to use in RF?

Answer 36

Etomidate

Question 37

Which induction drug do you probably want to avoid in RF?

Answer 37

Ketamine - HTN (and these pt's are usually already Hypertensive)

Question 38

How much does Sch usually increase the K+ by in a normal healthy person?

Answer 38

.5 - 1mEq/l

Question 39

You want to be careful with positioning and RF pt's why?

Answer 39

Hypocalcemia (fracture risk) | neuropathies (median and common peroneal most common)

Question 40

__________ is in IHA causes an increase in K & acidosis & can lead to myocardial irritability

Answer 40

halothane

Question 41

which two inhalational agents should you certainly avoid in RF?

Answer 41

Halothane and enflurane

Question 42

Which two inhalational agents are safest for RF pt's d/t no dependence on kidney for elimination?

Answer 42

Iso and Des

Question 43

What is the concern with RF and reversal agents?

Answer 43

They are primarily excreted renally and will have a prolonged half life.

Question 44

Under anesthesia, if your RF patient needs diuresis, how much lasix should you give?

Answer 44

very small doses!! 5mg

Question 45

Your RF pt is coming in for a AV fistula shunt placement. Would regional be a good choice? why and why not?

Answer 45

Yes - for vasodilation | No - coagulapathy and more at risk for seizure with toxicity

Question 46

Would you rather use alpha or beta adrenergic agents for hypotension in your RF patient?

Answer 46

Beta - does not result in renal vasoconstriction but increases myocardial irritability

Question 47

Which GI prophylaxis med would i want to avoid in my RF patient?

Answer 47

Reglan

Question 48

To give Regional anesthesia for a cystoscopy, I would want to do sensory level at _____ block but would know that the __________ nerve would not be blocked.

Answer 48

T10 | Obturator

Question 49

What is TURP syndrome?

Answer 49

systemic absorption of irrigating fluid in venous sinuses around prostate leads to hyponatremia

Question 50

To help prevent TURP syndrome, what are 2 important things we can do?

Answer 50

- limit the height of the fluid bags to less than 40cm above prostate - limit resection time to less than 1hr

Question 51

What are the ESWL shock waves timed to?

Answer 51

20ms after the R wave ( Ventricular refractory period)

Question 52

Would you want to use GA or RA for a ESWL?

Answer 52

Light GA with muscle relaxant to control diaphragmatic excursion (want it decreased)

Question 53

If you did a regional anesthetic on your ESWL patient, what level of blockade would you require?

Answer 53

T6 - and this is very uncomfortable because they can't feel their respirations.

Question 54

How would you describe the desired respirations during a ESWL procedure?

Answer 54

Short, frequent, small TV's (jet ventilation can be helpful)