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Advanced Anesthesia Test#1 > Urologic Procedures > Flashcards

Urologic Procedures Flashcards

0
Q

Absolute contraindications to EWSL

A

Pregnancy

Bleeding Disorder

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1
Q

What level of a spinal is needed for a ESWL

A

T4-T6

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2
Q

Relative contraindications to ESWL

A 
AICD
Pacemaker 
Morbid Obesity
Large calcification 
Renal Artery Aneurysms
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3
Q

When are shock waves delivered on ESWL

A

Shock waves ware defined to discharged 20 ms after the R wave

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4
Q

Immersion in heated bath causes physiologic alterations

CV effects

A

Increases central blood volume (CVP, blood pressure, and PA pressures increases)

Some patients can can have vasodilation resulting in hypotension

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5
Q

Immersion in heated bath causes physiologic alterations

Resp. Effects

A

Decrease VC, FRC, VT ; increased RR because WOB is increased

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6
Q

How do you put pt in the bath and with what monitors.

A

Hemodynamics, temperature, and O2

And gradual immersion in warm water

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7
Q

What is turp syndrome

A

The inter-vascular absorption of irrigation fluid can have neurological and cardiopulmonary consequences

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8
Q

When do the S/S occur

A

Intra op and post op

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9
Q

Serum Na level of 120 S/S

A

Possible widening of the QRS

restlessness and confusion

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10
Q

Serum Na level of 115

A

Widened QRS elevated ST

Nausea / Solmnolence

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11
Q

Serum Na level of 110

A

V-tach
V-fib

Seizures
Coma

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12
Q

Tx for TURP syndrome

A

Notify the surgeon to stop procedure
Send blood to lab
Insert invasive monitors

> 120 are mild and give pt fluid for BP support and lasix

< 120 give 3% Na and no IV greater than 100 ml/hr

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13
Q

Estimated blood loss in a TURP

A

Usually 2-4 ml/min

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14
Q

Increase bleeding with ___(2)_____ during a TURP

A

Larger prostate

Procedures lasting longer than 90 mins

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15
Q

How much blood for a prostate < 30 grams

A

No cross match

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16
Q

How much blood for a prostate 30-80 grams

A

Type and cross 2 UNITs

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17
Q

How much blood for a prostate >80 grams

A

Type and cross 4 units

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18
Q

Hydrostatic pressures of the irrigating pressures during a TURP

A

Height no >30 above the bed in the beginning

Height no >15 above the bed at the end. (Working on veins in the end)

19
Q

Absorption of irrigants can lead to what physiologic alterations

A

Increased myocardial work

Dilution of blood proteins and electrolytes

Rapid hyponateremia resulting in fluid overload, pulmonary edema, cerebral edema, cardiac dysrhymias

20
Q

The volume of irritant being absorbed is determined by (4 things)

A

of the venous sinuses

Duration obtuse resection (<1hr)

Hydrostatic pressure of the irrigation

The irritant and blood interface (keep the pt Blood pressure high)

22
Q

Advantages and disadvantages of distiller water

A

A: superior visibility and non el

D: hemolysis, hemoglobionemia, hyponateremia

23
Q

Advantages and disadvantages of glycine

most commonly used

A

Decreases likelihood of TURP Syndrome because it is isotonic.

Glycineis a non-essential amino metabolized into ammonia that crosses the BBB

Transient Blindness
Hyperglycemia
Coma

Inhibitory neurotransmitter that inhibits the release of NE and dopamine resulting in hypotension

24
Q

Advantages and disadvantages of cytal (sorbitol & mannitol)

Second most common

A

Decreased likelihood of TURP SYNDROME

Hyperglycemia

25
Q

Advantages and disadvantages of NS

A

Minimal effects with absorption

Dispenses current during electro- caterty

26
Q

What is the most common urologic procedure

A

Cystoscopy

27
Q

what are some indications for cystoscopy?

A 
Hematuria (Most Common)
Recurrent urinary tract infections
Renal calculi
Urinary tract obstruction
Bladder Biopsy
Resection of Bladder tumors
Placement of ureteral catheter stents
28
Q

Compare old scopes to new scopes

A

Old were ridged and now they are flexible

Lubricate with viscus lidocaine

29
Q

when the surgeon goes into the urethra should the patient deep or light

A

deep

30
Q

Lithotomy has what effects on the pulmonary system

A

Decrease the FRC
decrease the V/Q ratio
can lead to hypoxia
increased risk for atelectasis

31
Q

Cardiovascular system changes with lithotomy

A

increase in central blood volume leads to increase BP and CVP…. can lead to CHF

32
Q

How do you lower the legs of a patient? and what physiological symptom can you expect?

A

in Unison to prevent hip and back injury

BP may drop after lowering

33
Q

Injury to the common perineal nerve?

A

injury to the lateral thigh on the strap can result in FOOT DROP

34
Q

Injury to the saphenous nerve

A

injury to the medial calf on the strap support resulting in calf numbness

35
Q

what happens in extreme flexion at thigh

A

injury to the sciatic nerve resulting in pain/numbess of pesterer leg.

36
Q

What is the most common nerve injury in the lithotomy position?

A

Brachial Plexus

37
Q

When should you use a Regional Block? and what level of block is required for a bladder surgery?

A

if the surgery is greater than 30 min. T10

Remember the hypotension from the sympathectomy and the hypotension from lower legs.

May want to give someone a IV fluid to increase their preload prior to surgery

38
Q

What is the Obturator Reflex?

A

External rotation and adduction of the thigh due to cautery current thru the lateral bladder wall.

Still present if someone has a spinal. Respose is obliterated with MRs

39
Q

What is a common risk for a bladder resection surgery?

A

Perforation

40
Q

What things can cause a bladder perforation?

A

Over distention of the bladder with irritants
the tip of the resectoscope
the energized wire loop

41
Q

what are the two types of bladder perforations?

A

Extraperitoneal (Most common)

Intraperitoneal

42
Q

What is the s/s of extraperitoneal bladder rupture and how is it treated

A

Periumbilical, supapublic, or inguinal pain
irregular return of the irrigation fluid

TX= drains, antibiotics, no surgery needed

43
Q

Intraperitonial s/s and treatment

A

Generalized pain– and., shoulder, chest
Pallor sweating
N/V
Abdominal rigidity (MUST OPEN AND REPAIR)

TX: surgery to open and repair the bladder.

44
Q

Why is continuous irrigation needed for a TURP?

A

distends the bladder, washes away any extra blood and tissue, and optimizes visibility.

45
Q

what weight must a prostate be under to be performed through a re-sectocope?

A

less than 60 gms

46
Q

What would be the properties of a perfect irrigation fluid?

A
  • isotonic and non-hemolytic if absorbed
  • non-electrolytic
  • non-metabolized
  • non-toxic
  • rapidly excreted
  • inexpensive (because hospitals are cheap)

Advanced Anesthesia Test#1 (4 decks)

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