Renal II Flashcards
Kidney: SNS, PNS, spine levels of pain conduc
T8-L1, X, T10-L1
Ureter: NS, PNS, spine levels of pain conduc
T10-L2, S2-4, T10-L2
Bladder NS, PNS, spine levels of pain conduc
T11-L2, S2-4, T11-L2 dome/S2-4 neck
Prostate NS, PNS, spine levels of pain conduc
T11-L2, S2-4, T11-2, S2-4
Penis NS, PNS, spine levels of pain conduc
L1-2, s2-4, s2-4
Scrotum NS, PNS, spine levels of pain conduc
Not sig, not sig, s2-4
Testes NS, PNS, spine levels of pain conduc
T10-l2, not sig, t10-l1
NMB completely reliant on urinary elim
Gallamine, metocurine
6 commonly used drugs totally dependent on renal elim
Digoxin, inotropes, aminoglycosides, vanc, cephalosporins, pcn
IV agents commonly used in anesthesia partially dependent on renal elim 5
Panc, barbs, atropine, glyco, neostigmine
Other drugs partially dep on renal elim 6
Edrophonium, milrinone, hydralazine, cycloserine, sulfonamides, chlorpropamide
Approved NMB in renal fail 6
Sux, atra, cis atra, miva, vec, roc
NMB to avoid in renal fail 4
D tubo, metocurine, panc, gallamine
Opioids approved in renal fail, ones to avoid repeat dosing (*), avoid
Approved: fent, morphine, remi, dilaudid. Avoid demerol
IV anesthetics: 4 approved, 2 to avoid
Prop, keta, etomidate, midaz ok. Avoid tpl and diazepam
4 drugs concerned about in renal fail
Thiazides, SNP, dig, abx
CM of crf: CO, oxy hgb curve shift, bp, sns activity
Increased, right shift, htn, attenuated
What should be reduced in mac cases
LA doses
Comorbidity to be aware of if doing regional
Autonomic hyperreflexia
Cysto: level needed for spinal/epidural, spinal doses, epidural doses
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
Cysto maintenance if GA: what not needed, minimal what
NMB. Narcotic
Signs of bladder perf in cysto
Unexplained htn, tachycardia, hypotension. Shoulder pain in PACU
Osmolality: glycine 1.2%, 1.5%
175, 220
Osmolality sorbitol 3.5%, mannitol 5%, cytal
165, 275, 178
Osmolality glucose 2.5%, urea 1%
139, 167
Irritant should be less than what height, fluid absorbed per surgical time
<60cm above surgical table, 20 ml/min of resection time
Turp: abx, ebl, ebl per resection time
80 mg gentamicin slowly, 500 ml, 2-4 ml/min of resection time
Technique of choice for anesthesia w m turp
Spinal
M turp mortality increase assoc with 4
Procedure >90 min, gland size >45gm, acute urinary retention, >80 yrs old
Turp: spinal level needed.why it may be better than ga
T10. Acute hyponatremia from turp syndrome could delay ga emergence
Why m turp more at risk for irrigation absorp
B turp and l turp can use ns
Turp syndrome: s/s
HA, restless, cyanosis, dyspnea, htn, inc/dec hr, CHF, coma, transient blindness, pulm edema, mi
Hyponatremia in turp: <120 se, <115, <102
120: confused, restless. <115: tired, nauseous, dec contractility, hypotension, wide qrs/st elev. <102: sz, coma, dysrhythmias, severe hypotension, pulm edema
Turp syndrome tx
Fluid restriction, loop diuretics, hypertonic saline if severe, cv support
Eswl: when shock delivered, pacer/aicd at risk for
Ventricular refractory period, arrhythmias
Eswl: abs contra 2, relative contra 4
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
Eswl preop: pts may have what which could alter anesthetic plan
Opioid tolerance if stone attack, NV (RSI), on diuretics (check k)
Eswl: anesthesia GA with ___ vent, MAC if regional where/what condition
Controlled. Flank infiltration and IC block if 3rd gen or newer lithotripter
ESWL: control ___ ___. Give what. Vent modes
Diaphragmatic excursion. NMB. HFJV
ESWL regional: __ __ most common, level required, cons to this method
Continuous epidural, T6. Can’t control diaphragm, hypotension higher risk
Laser lithotripsy: which anesthesia method advised. If regional need what level. ___ patient well.
General w/NMB. T8-10. Hydrate
Perc nephrostomy: pt positioning. Risks to pt
Lithotomy then prone. Trauma to spleen/liver/kidney, ptx, bleeding
Radical prostatectomy: co ex diseases, risk of what, need what kind of access
CAD, COPD, renal dysfunc. Sig blood loss. Wide IV and invasive monitoring
Radical prostatectomy: consider what for blood control, __ __ position, risk of what
ANH or autologous blood donation, hyper extended, VAE
Radical prostatectomy: surgeon may ask to give what, SE
Indigo carmine, alters p ox readings
First sign vessel has been knicked in prostatectomy
End tital drop
Access for radical prostatectomy
Aline, 1-2 large IVs
Fluid for radical prostatectomy
NS or LR 5 ml/kg/hr
Reg for radical prostatectomy: need what level, what used for spinal v epidural
T8. Spinal: 0.75% bupiv or hyperbaric tetracaine. Epidural 1.5-2% epi 20 ml
5 complications of radical prostatectomy
Hemorrhage, hypothermia, vae, common peroneal injury d/t lithotomy position, dvt w pe
Pain mgmt for radical prostatectomy
Morphine 2-4 mg q 10-15 min or pca
Radical nephrectomy: access, co ex diseases 5
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
Radical nephrectomy: levels that may be inc/altered
Hypercalcemia, eosinophilia, inc prolactin, EPO, glucocorticoids
Nephrectomy for RCC: co ex diseases 3, most pts are what, may need what preop
Htn, dm, smoking. Anemic. TRANSFUSION
RCC nephrectomy: expect what intraop 2
Extensive blood loss. Retraction of IVC leads to hypotension
Prostate cx pelvic lymph dissec: positioning, potential for what, avoid using what/why
Steep trend, hypothermia from irritant, nitrous- prevent bowel distension
Bilateral orchid to my: procedure duration
20 min, dont use long acting agents
Bladder cx: what is linked to it, may receive what preop
Smoking. Radiation
Radical cystectomy: expect large what, which anes method preferred, access
Blood loss. Ga w NMB. A line, cvp if cardiac pt
Radical orchid to my: pts typically ___ and have what. Which chemo used/se. Can use what kind of anesthesia
Young. Bone marrow supp. Bleomycin, pulm fibrosis. RA or ga
