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Adv Pr III > Renal II > Flashcards

Renal II Flashcards

1
Q

Kidney: SNS, PNS, spine levels of pain conduc

A

T8-L1, X, T10-L1

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2
Q

Ureter: NS, PNS, spine levels of pain conduc

A

T10-L2, S2-4, T10-L2

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3
Q

Bladder NS, PNS, spine levels of pain conduc

A

T11-L2, S2-4, T11-L2 dome/S2-4 neck

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4
Q

Prostate NS, PNS, spine levels of pain conduc

A

T11-L2, S2-4, T11-2, S2-4

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5
Q

Penis NS, PNS, spine levels of pain conduc

A

L1-2, s2-4, s2-4

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6
Q

Scrotum NS, PNS, spine levels of pain conduc

A

Not sig, not sig, s2-4

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7
Q

Testes NS, PNS, spine levels of pain conduc

A

T10-l2, not sig, t10-l1

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8
Q

NMB completely reliant on urinary elim

A

Gallamine, metocurine

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9
Q

6 commonly used drugs totally dependent on renal elim

A

Digoxin, inotropes, aminoglycosides, vanc, cephalosporins, pcn

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10
Q

IV agents commonly used in anesthesia partially dependent on renal elim 5

A

Panc, barbs, atropine, glyco, neostigmine

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11
Q

Other drugs partially dep on renal elim 6

A

Edrophonium, milrinone, hydralazine, cycloserine, sulfonamides, chlorpropamide

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12
Q

Approved NMB in renal fail 6

A

Sux, atra, cis atra, miva, vec, roc

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13
Q

NMB to avoid in renal fail 4

A

D tubo, metocurine, panc, gallamine

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14
Q

Opioids approved in renal fail, ones to avoid repeat dosing (*), avoid

A

Approved: fent, morphine, remi, dilaudid. Avoid demerol

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15
Q

IV anesthetics: 4 approved, 2 to avoid

A

Prop, keta, etomidate, midaz ok. Avoid tpl and diazepam

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16
Q

4 drugs concerned about in renal fail

A

Thiazides, SNP, dig, abx

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17
Q

CM of crf: CO, oxy hgb curve shift, bp, sns activity

A

Increased, right shift, htn, attenuated

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18
Q

What should be reduced in mac cases

A

LA doses

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19
Q

Comorbidity to be aware of if doing regional

A

Autonomic hyperreflexia

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20
Q

Cysto: level needed for spinal/epidural, spinal doses, epidural doses

A

T8-10. Spinal: 0.75% 10-12 mg >1 hr, 7.5 if less <1 hr. Epidural: 1.5-2% lido w epi 15-25 ml, 5-10 ml bolus

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21
Q

Cysto maintenance if GA: what not needed, minimal what

A

NMB. Narcotic

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22
Q

Signs of bladder perf in cysto

A

Unexplained htn, tachycardia, hypotension. Shoulder pain in PACU

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23
Q

Osmolality: glycine 1.2%, 1.5%

A

175, 220

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24
Q

Osmolality sorbitol 3.5%, mannitol 5%, cytal

A

165, 275, 178

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25
Q

Osmolality glucose 2.5%, urea 1%

A

139, 167

26
Q

Irritant should be less than what height, fluid absorbed per surgical time

A

<60cm above surgical table, 20 ml/min of resection time

27
Q

Turp: abx, ebl, ebl per resection time

A

80 mg gentamicin slowly, 500 ml, 2-4 ml/min of resection time

28
Q

Technique of choice for anesthesia w m turp

A

Spinal

29
Q

M turp mortality increase assoc with 4

A

Procedure >90 min, gland size >45gm, acute urinary retention, >80 yrs old

30
Q

Turp: spinal level needed.why it may be better than ga

A

T10. Acute hyponatremia from turp syndrome could delay ga emergence

31
Q

Why m turp more at risk for irrigation absorp

A

B turp and l turp can use ns

32
Q

Turp syndrome: s/s

A

HA, restless, cyanosis, dyspnea, htn, inc/dec hr, CHF, coma, transient blindness, pulm edema, mi

33
Q

Hyponatremia in turp: <120 se, <115, <102

A

120: confused, restless. <115: tired, nauseous, dec contractility, hypotension, wide qrs/st elev. <102: sz, coma, dysrhythmias, severe hypotension, pulm edema

34
Q

Turp syndrome tx

A

Fluid restriction, loop diuretics, hypertonic saline if severe, cv support

35
Q

Eswl: when shock delivered, pacer/aicd at risk for

A

Ventricular refractory period, arrhythmias

36
Q

Eswl: abs contra 2, relative contra 4

A

Abs: pregnant, untreated bleeding disorder. Relative: aicd (turn off for procedure), pacer (turn to non demand mode), aortic or renal artery aneurysm (if big), morbid obesity

37
Q

Eswl preop: pts may have what which could alter anesthetic plan

A

Opioid tolerance if stone attack, NV (RSI), on diuretics (check k)

38
Q

Eswl: anesthesia GA with ___ vent, MAC if regional where/what condition

A

Controlled. Flank infiltration and IC block if 3rd gen or newer lithotripter

39
Q

ESWL: control ___ ___. Give what. Vent modes

A

Diaphragmatic excursion. NMB. HFJV

40
Q

ESWL regional: __ __ most common, level required, cons to this method

A

Continuous epidural, T6. Can’t control diaphragm, hypotension higher risk

41
Q

Laser lithotripsy: which anesthesia method advised. If regional need what level. ___ patient well.

A

General w/NMB. T8-10. Hydrate

42
Q

Perc nephrostomy: pt positioning. Risks to pt

A

Lithotomy then prone. Trauma to spleen/liver/kidney, ptx, bleeding

43
Q

Radical prostatectomy: co ex diseases, risk of what, need what kind of access

A

CAD, COPD, renal dysfunc. Sig blood loss. Wide IV and invasive monitoring

44
Q

Radical prostatectomy: consider what for blood control, __ __ position, risk of what

A

ANH or autologous blood donation, hyper extended, VAE

45
Q

Radical prostatectomy: surgeon may ask to give what, SE

A

Indigo carmine, alters p ox readings

46
Q

First sign vessel has been knicked in prostatectomy

A

End tital drop

47
Q

Access for radical prostatectomy

A

Aline, 1-2 large IVs

48
Q

Fluid for radical prostatectomy

A

NS or LR 5 ml/kg/hr

49
Q

Reg for radical prostatectomy: need what level, what used for spinal v epidural

A

T8. Spinal: 0.75% bupiv or hyperbaric tetracaine. Epidural 1.5-2% epi 20 ml

50
Q

5 complications of radical prostatectomy

A

Hemorrhage, hypothermia, vae, common peroneal injury d/t lithotomy position, dvt w pe

51
Q

Pain mgmt for radical prostatectomy

A

Morphine 2-4 mg q 10-15 min or pca

52
Q

Radical nephrectomy: access, co ex diseases 5

A

Large iv, a line, central line left side if ivc involved or if not same side as nephrectomy. Paraneoplastic syndrome, smoking, cad, COPD, renal failure

53
Q

Radical nephrectomy: levels that may be inc/altered

A

Hypercalcemia, eosinophilia, inc prolactin, EPO, glucocorticoids

54
Q

Nephrectomy for RCC: co ex diseases 3, most pts are what, may need what preop

A

Htn, dm, smoking. Anemic. TRANSFUSION

55
Q

RCC nephrectomy: expect what intraop 2

A

Extensive blood loss. Retraction of IVC leads to hypotension

56
Q

Prostate cx pelvic lymph dissec: positioning, potential for what, avoid using what/why

A

Steep trend, hypothermia from irritant, nitrous- prevent bowel distension

57
Q

Bilateral orchid to my: procedure duration

A

20 min, dont use long acting agents

58
Q

Bladder cx: what is linked to it, may receive what preop

A

Smoking. Radiation

59
Q

Radical cystectomy: expect large what, which anes method preferred, access

A

Blood loss. Ga w NMB. A line, cvp if cardiac pt

60
Q

Radical orchid to my: pts typically ___ and have what. Which chemo used/se. Can use what kind of anesthesia

A

Young. Bone marrow supp. Bleomycin, pulm fibrosis. RA or ga

Adv Pr III (4 decks)

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