Renal Flashcards
What is the spinal level needed for TURP?
T10
What are the benefits of spinal anesthesia for TURP?
monitoring mental status
early detection of capsular tears and bladder perforation (shoulder pain)
vasodilation (less circulatory overload)
less bleeding
post-operative analgesia
What is the irrigation solution used in monopolar TURP? Why?
usually glycine
it is isotonic, electrically inert, nontoxic, and transparent
How is bladder irrigaiton absorbed during TURP?
prostatic venou sinuses
periprostatic and retroperitoneal space
bladder perforation
What are the risk factors for TURP syndrome?
large prostate
capsular violation during surgery
irrigant pressure
What causes CNS dysfunction during TURP syndrome?
hypo-osmolality leading to cerebral edema
How do you treat TURP syndrome?
furosemide
oxygen, consider intubation
benzodiazepines for seizures
consider hypertonic saline
What are the toxic effects of glycine?
direct toxiciy to heart and retina
metabolites are ammonia (CNS changes) and oxalic acid (renal toxicity)
What is the timecourse of TURP-related blindness?
resolves between 8-48 hours post-operatively
What can cause DIC during TURP?
increased thromboplastin from prostate particles
How does ESRD cause cardiac dysfunction?
vascular calcification
uremia leading to cardiac fibrosis and LV dysfunction
What is the perservative solution used in a donor kidney?
similar to intracellular fluid (low sodium, high potassium)
What immunosuppressive drugs are given intraoperatively during kidney transplant?
methylprednisolone
mycophenolate mofetl
ATG (or basiliximab)
What are the CVP goals during kidney transplant?
12-14 mmHg
What is the normal increase in potassium after succinylcholine administration?
0.5-1.0 mEq/L
