Surgical Recovery Flashcards
You are required to share a zero antigen mismatch kidney. Who determines which kidney to offer to the receiving center?
- -The receiving OPO chooses which kidney they wish to import.
- -The transplant center whose recipient has accumulated the most points on the allocation waiting list chooses the kidney.
- -The host OPO’s recovering surgeon determines which kidney will be kept locally.
The host OPO’s recovering surgeon determines which kidney will be kept locally
At what temperature should Perfadex lung flush be used?
- 4-8 degrees Celcius / 39-46 deg F
- -16-20 C / 31-68 F
- 2-3 C / 35-37 F
4-8 degrees Celcius / 39-46 deg F
What is the most common hepatic vascular aberrancy?
- -An aberrant Right hepatic artery, which comes from the superior mesenteric artery.
- -An aberrant branch of the hepatic artery from the left gastric artery. It supplies the left lobe of the liver.
- -An aberrant splenic artery, which supplies the left lobe of the liver.
An aberrant branch of the hepatic artery from the left gastric artery. It supplies the left lobe of the liver.
What causes reperfusion injury?
- -Pumping kidneys causes reperfusion injury.
- -Flush solutions are run too rapidly and damage the newly-transplanted organ.
- -Cellular changes that occur during cold storage become noted during transplant and reperfusion. The result is decreased organ function.
Cellular changes that occur during cold storage become noted during transplant and reperfusion. The result is decreased organ function.
Why is the Univ. of Wisconsin (UW) solution never used for pre-cool fluid in the portal line flush?
- -The high concentration of potassium could cause the heart to stop prematurely.
- -UW or Belzer’s solution is only used to package organs for research.
- -The low concentrations of potassium make UW the gold standard of pre-cool fluid in the portal line flush. However, the cost of UW makes use of the solution for pre-cool impractical.
The high concentration of potassium could cause the heart to stop prematurely.
The hepatic artery supplies 25% of the hepatic blood supply. The remaining 75% comes from which vessel?
- -Gastroduodenal artery
- -Portal vein
- -Superior mesenteric artery
Portal Vein
What is the maximum Custodial HTK cold storage time for a pancreas?
- -24 hours at 2-4 deg C, 36-39 F
- -15 hours at 2-4 deg C, 36-39 F
- -6 hours at 2-4 deg C, 36-39 F
15 hours at 2-4 deg C, 36-39 F
If the liver is to be pre-cooled prior to cross-clamp, into which vessel is the cannula inserted?
- -Splenic vein
- -Inferior vena cava
- -Renal vein
Splenic Vein
When organs are removed from the body they begin to die. The goal of perservation is to slow down the biochemical processes that lead to cell death. What are the preservation factors that affect the success of the subsequent transplant?
- -Method of preservation (cold storage, continuous perfusion), composition of preservation solution and length of preservation.
- -Cause of death and hemodynamic stability.
- -Age, reperfusion injury, and phamacological agents used post-transplant.
Method of preservation (cold storage, continuous perfusion), composition of preservation solution and length of preservation.
Biopsies of kidneys are frequently done in the OR. What resulting information is being assessed?
- -Percentage of sclerosed glomeruli
- -Specific tissue sub-typing
- -Degree of creatinine clearance
Percentage of sclerosed glomeruli
How much ischemic time can the kidney tolerate when packaged in Custodial HTK solution?
- -48 hrs at 2-4 deg C, 36-39 F
- -24 hrs at 2-4 C, 36-39 F
- -12 hrs at 2-4 C, 36-39 F
48 hrs at 2-4 deg C, 36-39 F
Where is the aortic cannula placed?
- -In the descending thoracic aorta, towards the distal direction
- -In the aorta, just above the aortic bifurcation, in the caudal direction
- -In the aorta at the level of the superior messenteric artery, in the caudal direction
In the aorta, just above the aortic bifurcation, in the caudal direction
You have been in the OR for one hour when the donor becomes very unstable. The HR is 220, the MAP is 50 mmHg, and SaO2 88%. What will be the most appropriate next action?
- -Recommend that the anesthesiologist increase the dopamine to 15mcg/kg/min and increase FiO2 to 100%.
- -Prepare flush solutions as quickly as possible for emergent cross-clamping and recovery of organs.
- -Hang 2 units PRBCs on a blood pump and temporarily increase dopamine until the blood pressure improves.
Prepare flush solutions as quickly as possible for emergent cross-clamping and recovery of organs.
Cross clamp occurred at 2214 MST. When the right kidney is subsequently transplanted, the clamp is removed from it at 1634 EST the following day. What is the CIT (cold ischemic time)?
- 6 hrs, 20 min.
- 17 hrs, 40 min.
- 16 hrs 20 min.
16 hrs 20 min.
If the pancreas is being recovered for transplant surgery it will typically take an additional 1 to 1 1/2 hours. What causes this additional time requriement?
- -Devascularization of the stomach and isolation of the duodenum adds this additional time.
- -The is a great deal more dissection of shared vasculature required, particularly with the liver.
- -The blood sugar must first be normalized, then flushing with amphotercin and betadine adds additional time
The is a great deal more dissection of shared vasculature required, particularly with the liver.
