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RUSVM Anesthesiology > Renal, CNS, And Hepatic Disease > Flashcards

Renal, CNS, And Hepatic Disease Flashcards

1
Q

Renal blood flow is constant within a mean arterial pressure of ???

A

80180mmHg
-glomerular afferent arteries are dilated or constricted to maintain a constant flow

*autoregulation altered by renal insufficiency/failure

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2
Q

T/F: most anesthetic drugs increase GFR and RBF in a dose dependent fashion

A

False

DECREASE GFR and RBF
-autoregulaiton is generally maintained at light planes of inhalant anesthesia

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3
Q

In renal disease, what drugs should you avoid?

A

Anesthetic causing hypotension or requiring renal excretion (eg ketamine in cats)

NSAIDS —> decreased prostaglandin production and cause renal ischemia

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4
Q

How do you manage renally compromised patients pre-op?

A 
Fluid diuretics 
Monitor electrolyte (potassium commonly high or low)
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5
Q

How do you manage renal compromised patients intra-op?

A

IV fluid mandatory -> usually high end of surgical rate

MAP maintained above 70-80 mmHg

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6
Q

T/F: feline urethral obstruction patients usually do not require general anesthesia

A

True

Especially if debilitated

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7
Q

How will you stabilize your feline urethral obstruction patient prior to surgery?

A

Hyperkalemia

  • > Ca gluconate (cardio protective)
  • > regular insulin +dextrose

Hypovolemia
-buffered isotonic IV fluids

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8
Q

What are the cardiovascular-sparing drugs that can be used in Feline urethral obstruction patients?

A

Opioids and benzos

AVOID ketamine

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9
Q

Cerebral blood flow is normally maintained by autoreguation at a MAP of ___________

A

50-150mmHg

Perfusion must be adequate to prevent hypoxia brain injury but not high causing increased ICP

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10
Q

Cerebral perfusion pressure =________-________

A

CPP = MAP - ICP

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11
Q

What can disrupt cerebral blood flow ?

A 
Tumors 
PaCO2 
PaO2 
Temperature 
Seizure 
Anesthetic 
Blood viscosity
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12
Q

Does the cerebral metabolic requirement for oxygen usually increase or decreased with anesthesia?

A

Usually decrease

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13
Q

What is the cushing reflex?

A

Severe increase ICP—> poor cerebral perfusion AND irregular breathing pattern

Leads to sympathetic response: vasoconstriction, increased cardiac output —> hypertension

Carotid baroreceptors sense hypertension —> reflex bradycardia

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14
Q

What sedatives can be used in patients with CNS dysfunction?

A

Acepromazine -> decrease seizure threshold

Benzodiazepines —> decreased CBF and ICP, Control seizure

Opioids -> minimal effect on CPF and ICP, vomiting can increase ICP

A2 agonists —> minimal CNS effects except for antagonist (atipamezole cause increase ICP), usually not nessesary

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15
Q

What induction agents are used in CNS disease patients?

A

Propofol and barbiturates -> preferred to decrease ICP and CBF (CRI)

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16
Q

T/F: ketamine can be used in patients with CNS disorders

A

False

Increases ICP and CBF

17
Q

Can neuromuscular blockers be used in patients with CNS disorders?

A

Non-depolarizing can

NOT succinylcholine -increase ICP

18
Q

Do volatile anesthetics increase or decrease ICP and CBF?

A

INCREASE

Halothane has the greatest effect and is not recommended
Nitrous oxide not recommended

19
Q

flip for fun fact..

A

Modest hyperventilation (pCO2 = 30=35) May eliminate the effects of iso and sevoflurane on CBF and ICP

20
Q

What happens if you have an accidental intracartoid injection in equine?

A

Causes violent behavioral reaction and seizures

Treat with thiopental +/- guaifenesin
Supplemental O2 and IV fluid

Continue sedation for 30mins, usually recover uneventfully

21
Q

What are clinical signs of liver disease and what do you see on biochem?

A

Depression, anorexia, wight loss
Icterus, ascities, abnormal behavior/mentation, seizure

DECREASED: albumin, BUN, glu, chol,

INCREASED: Tbili , ammonia, bile acids, PT/PTT

22
Q

What factors in patients with hepatic disease increase anesthetic risk?

A

Low albumin/portal hypertension —> ascities

Decreased coag factors —> hemorrhage

Decreased gluconeogensis —> hypoglycemia

Increased ammonia and other toxins —> encephalopathy/coma

23
Q

Hepatic disease has what effect on duration and action of most drugs?

A

Prolonged action and increased action (slower metabolism in diseased liver)

24
Q

_________________ may worsen signs of hepatic encephalopathy

A

Benzodiazepines

25
Q

What two drug types are minimally metabolized by the liver?

A

Inhalant anesthetics

Ester local anesthetic

26
Q

What type of fluids are NOT recommended in hepatic disease.?

A

Lactate-containing fluids —> requries hepatic metabolism

27
Q

What drugs are preferred for induction in hepatic disease?

A

Opioid (morphine constrict sphincter of Oddi in human, may want to avoid in gall bladder dz)

Propofol
Alfaxalone
Etomidate

28
Q

What are the preferred maintenance drugs in hepatic disease?

A

ISO increases total hepatic blood flow

Sevoflurane and des decreases flow but is probably not clinically relevant

29
Q

If you need a NMBD in a patient with hepatic dz which would you choose?

A

Atracurium

30
Q

Can lidocaine, bupivacaine and mepivicaine be used in animals with hepatic disease ?

A

Yes but decrease the dose

31
Q

What drugs are contraindicated in hepatic disease ?

A

Acepromazine - vasodilation decreased BP and inhibit platelet aggregation

A2 agonsit - decreased CO

Barbiturates - depends on hepatic metabolism and highly protein bound

Halothane - decrease hepatic blood flow, met by liver

Succinylcholine - cholinesterase synthesized by live r

Guaifenesin - met by liver, metabolite can cause toxic neuro effects and is increased with hepatic disese

32
Q

What are the intra-operative considerations with hepatic Denise?

A

Maintain liver perfusion

Monitor glucose, supplement as needed

Monitor hemorrhage, transfuse as needed

Monitor depth of anesthesia, drug requirements may need to be decreased

Maintain normal body temp

33
Q

When doing a portosystemic shunt ligation. You should closely monitor??

A

Arterial BP

Hypotension may not be dobutamine or dopamine responsive

RUSVM Anesthesiology (32 decks)

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