Renal - Anesthesia Flashcards
Why are pts w renal dz more susceptible to barbiturates (brevital) and benzos?
decreased protein binding therefore more free drug available
Which three anesthetic IV agents have no significant differences in uremic pts?
- Propofol
- Etomidate
- Ketamine
What is the major concern w diazepam (Valium) in a renal pt?
active metabolites can accumulate
Which 2 opioids warrant caution in a renal pt? Why?
Morphine and meperidine (Demerol)
accumulation of metabolite can cause problems (resp depression and seizures, respectively)
Although Atropine and glyco can be used safely in renal pts, what can occur w repeated dosing?
accumulation of metabolites
What are the renal implications of Metoclopramide?
it is partly excreted unchanged by kidney but it can accumulate in renal failure
Generally save to use in single dose
Sucs is safe in pts w K _______ mEq/L
<5.0 mEq/L
What is the musc relaxant of choice in a renal pt? Why?
Cisatracurium
It is degenerated by Hoffman elimination
NDNMBs to avoid in renal pts b/c they are primarily dependent on renal excretion
- Pancuronium
- Pipecuronium
- Alcuronium
- Doxacurium
Where are Vec and Roc primarily eliminated>
Liver
Although there is some mild prolongation in RF pts
How are NDNMB reversal agents affected by RF?
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
Surgery should be performed _______ hrs after last dialysis
6-8 hrs
6 Factors to evaluate in a renal pt preoperatively
- Last dialysis
- Most recent K
- Systemic effects of kidney dz
- EKG
- RBC transfusion for hgb <6-7
- dialysis access site
Intraoperative concerns on a renal pt
- No BP cuff on fistula arm
- Use invasive hemodynamic monitors
- Avoid LR b/c of K
- control ventilation to decrease risk of resp acidosis (on top of the metabolic acidosis they probably already have)
Pts w which comorbidity (along w renal fail) have 10X the peri-op morbidity of pts w this comorbidity and no RF
DM