Renal - Anesthesia Flashcards

1
Q

Why are pts w renal dz more susceptible to barbiturates (brevital) and benzos?

A

decreased protein binding therefore more free drug available

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2
Q

Which three anesthetic IV agents have no significant differences in uremic pts?

A
  1. Propofol
  2. Etomidate
  3. Ketamine
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3
Q

What is the major concern w diazepam (Valium) in a renal pt?

A

active metabolites can accumulate

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4
Q

Which 2 opioids warrant caution in a renal pt? Why?

A

Morphine and meperidine (Demerol)

accumulation of metabolite can cause problems (resp depression and seizures, respectively)

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5
Q

Although Atropine and glyco can be used safely in renal pts, what can occur w repeated dosing?

A

accumulation of metabolites

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6
Q

What are the renal implications of Metoclopramide?

A

it is partly excreted unchanged by kidney but it can accumulate in renal failure

Generally save to use in single dose

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7
Q

Sucs is safe in pts w K _______ mEq/L

A

<5.0 mEq/L

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8
Q

What is the musc relaxant of choice in a renal pt? Why?

A

Cisatracurium

It is degenerated by Hoffman elimination

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9
Q

NDNMBs to avoid in renal pts b/c they are primarily dependent on renal excretion

A
  • Pancuronium
  • Pipecuronium
  • Alcuronium
  • Doxacurium
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10
Q

Where are Vec and Roc primarily eliminated>

A

Liver

Although there is some mild prolongation in RF pts

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11
Q

How are NDNMB reversal agents affected by RF?

A

reversal agents are primarily excreted by the kidney but their half-lives are prolonged ~ as much as some of the NDNMBs so over all, there is usually not problem

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12
Q

Surgery should be performed _______ hrs after last dialysis

A

6-8 hrs

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13
Q

6 Factors to evaluate in a renal pt preoperatively

A
  1. Last dialysis
  2. Most recent K
  3. Systemic effects of kidney dz
  4. EKG
  5. RBC transfusion for hgb <6-7
  6. dialysis access site
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14
Q

Intraoperative concerns on a renal pt

A
  1. No BP cuff on fistula arm
  2. Use invasive hemodynamic monitors
  3. Avoid LR b/c of K
  4. control ventilation to decrease risk of resp acidosis (on top of the metabolic acidosis they probably already have)
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15
Q

Pts w which comorbidity (along w renal fail) have 10X the peri-op morbidity of pts w this comorbidity and no RF

A

DM

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16
Q

Key factor in the causation of periop renal failure

A

Hypovolemia

17
Q

post-op renal failure has a mortality of ______

A

~50%

18
Q

T/F: it is easier to tx the complications of fluid overload than it is to tx ARF

A

True

19
Q

Should renal dose dopamine ever be used?

A

No. It may do more harm than good

20
Q

Risk factors for peri-op RF

A
  • Sepsis
  • Hypovolemia
  • Obstructive jaundice
  • Aminoglycoside antibiotics
  • NSAIDS
  • ACE inhibitors
  • Recent dye injections
21
Q

Renal pts on ACE inhibitors can be resistant to _______ and _______ but respond well to _______

A

phenylephrine and ephedrine

vasopressin

22
Q

Mgmt for intra-op oliguria

A
  1. Make sure foley is patent
  2. Check fluid status/give bolus
  3. Check CVP or PAC
  4. Increase low BP
  5. Give lasix if home med that wasn’t taken day of surgery
  6. Consider mannitol