Renal Flashcards
What effects do alpha 2s have on the kidneys?
- increase urine production
1. decrease ADH
2. anti-insulin effect: incr plasma glucose, which leads to osmotic diuresis
How does renal ischemia occur during anesthesia?
systemic hypotension –> peripheral vasodilation
** seen with inhalants, phenothiazines
anesthesia and surgery related stress
- release of aldosterone, catecholamines, vasopressin, and renin
- dec renal blood flow, GFR, and urine production
what effects does ketamine have on the kidneys?
- increases renal blood flow
- decrease or no change in in GFR
how does isoflurane affect the kidneys?
slightly decreases renal blood flow and GFR
what are the effects of renal insufficiency on anesthesia?
- azotemia
- acidosis
- hyperkalemia
- hypocalcemia causes cardiac dysfunction
- cardiac dysrhythmias - anemia
what blood pressure should renal patients be maintained at?
MAP> 70 mmHg
tranquilizers and sedatives in renal and hepatic patients
avoid phenothiazines and alpha 2s
-cause hypotension and dysrhythmias
portocaval shunts have excess response to benzos, so good in patients with liver disease
***reversible
opioids in hepatic patients
- morphine constricts sphincter of Oddi
- morphine and meperidine cause histamine release, decreased total hepatic blood flow
- decreased oxygenation (incr HR and ventilation)
- hypotension
dissociatives in hepatic patient
Give IV
-may induce seizures in horses and dogs (give with heavy sedation)
neuromuscular blockers in hepatic patients
-prolonged metabolism in liver
-atracurium undergoes Hoffman elimination
-depolarizing agents (succinylcholine) degraded by plasma cholinesterase
> prolonged in hepatic patients
which drugs should be AVOIDED in hepatic patients?
-ketamine, tiletamine, methohexital
