Urology Flashcards
caudal blocks:
- peds up to how many kg?
- what is the cap of mLs she gives?
- what is the mL/kg?
- what are the 3 LAs? (B,R,R)
- which one can be given as the sole anesthetic?
- what age does she usually stop doing caudals?
- 20 kg
- 30 mL
- 1 mL/kg
- 0.125% bupivacaine with epi, 0.2% ropivacaine with or without epi, 0.375% ropivacaine with epi
- 0.375% ropivacaine with epi
- 6 years
does 0.375% ropivacaine with provide the sole anesthetic for laparoscopic, open or both?
open
caudal block:
- what gauge needle?
- locate what spines and palpate what cornu? (PSIS, SC)
- advance the needle at what degree cephalad or caudal?
- what ligament are you piercing with the needle? (SL)
- 22 gauge
- posterior superior iliac spines, sacral cornu
- 45 degrees cephalad
- sacrococcygeal ligament
strangulated bowel loop:
- is this an emergency?
- what type of intubation technique?
- do you mask them?
- yes
- RSI
- no
posterior urethral valves:
- spectrum of urethral what that vary from mild to severe? (O)
- is prenatal or postnatal more severe?
- ultrasound can diagnosis this prenatal by what 3 signs? (BD, M, H)
- what are the 3 postnatal signs? (DUO, UR, PUS)
- obstruction
- prenatal
- bladder distention, megaureters, hydronephrosis
- decreased urine output, urinary retention, poor urine stream
avoid anesthesia within how many hours of dialysis to prevent hypovolemia?
12 hours
posterior urethral valves:
- when renal insufficiency occurs, the concentration mechanism is often impaired leading to an increase or decrease in urine output?
- does this lead to relative hypervolemia or hypovolemia?
- treatment is primary valve what to decompress the urogenital system? (A)
- what is anesthesia plan for this procedure?
- increase
- hypovolemia
- ablation
- GA with LMA
what are the 4 anesthesia worries with the primary valve ablation performed under cystoscopy? (AD, H, PNI, EA)
- airway distance
- hypothermia
- peroneal nerve injury
- electrolyte abnormalities
Vesicoureteral reflux:
- what is happening?
- what 3 steps can result? (P, RS, DRF)
- mild forms are treated with what? (A)
- in severe forms, what is injected into the ureter to prevent reflux? (D)
- what classic surgery is performed for this? (UR)
- urine reflux from the bladder to the ureters
- pyelonephritis, renal scarring, decreased renal function
- antibiotics
- deflux
- ureter reimplantation
what is the antibiotic given for vesicoureteral reflux?
bactrim
ureteral reimplantation:
- postop pain is often intense necessitating 2 to 3 days of continuous LA via an indwelling catheter, which can be in what 2 areas? (C, L)
- what anesthesia technique for this procedure?
- are neuromuscular blockers needed?
- caudal, lumbar
- GETA
- yes
pyeloplasty:
- what is surgically reconstructed in this procedure? (RP)
- this procedure is indicated for renal congestion, what is the common junction for renal congestion? (UJ)
- procedure can be performed in what position and does this position increase or decrease venous return?
- what is the anesthetic technique for this procedure and is it with or without paralytics?
- renal pelvis
- ureteropelvic junction
- jackknife, decrease
- GETA with paralytic
what are pts who undergo a ureteral reimplantation on that pts who undergo a pyeloplasty not on?
antibiotics
what is the main anesthetic implications difference between pts undergoing a ureteral reimplantation and pyeloplasty? (P)
positioning
pyeloplasty:
- what 2 positions can this be performed in?
- where is the epidural catheter placed for this procedure? (HL, LT)
- what LA is given after catheter insertion to set the block before the table is jackknifed?
- what 2 LAs can be given after as an infusion? (B, R)
- prone, lateral
- high lumbar, low thoracic
- 2% lidocaine with epi
- bupivacaine, ropivacaine
laparoscopic pyeloplasty:
1. mean retroperitoneal pressure of how much can increase PETCO2, increase peak inspiratory pressure and decrease BP?
- 12 mmHg
what are the 5 anesthesia concerns with cystoscopy pyelograms? (DFA, PND, H, CA, AA)
- distance from airway
- peroneal nerve damage
- hypothermia
- contrast allergy
- amoxicillin allergy
why can’t we use a lower bair hugger for cystoscopy pyelograms? (B)
burns
what are 5 ways to increase pts temp? (H, FA, IRT, HOH, WF)
- HME
- forced air
- increase room temp
- hat on head
- warm fluids
nephrectomy:
- does a partial or total have more blood loss?
- what 3 labs should be checked?
- these peds are often anemic possibly d/t decrease what concentration? (E)
- what 2 things can be given 3-6 weeks before surgery to help improve anemia? (FS, VC)
- if pt is being staged for a transplant, what should be avoided? (BT)
- partial
- H&H, electrolytes, coags
- erythropoietin
- ferrous sulfate, vitamin C
- blood tranfusions
nephrectomy:
- blood transfusion should be given to increase what and not as a what? (OCC, VE)
- size of these pts should be considered when setting up anesthesia equipment, are these children larger or smaller in size?
- what anesthesia technique no matter open or laparoscopic?
- what 2 IV catheters do you want? (LP, AL)
- oxygen carrying capacity, volume exander
- smaller
- GETA
- large PIV, art line
nephrectomy:
- for open procedure, what are the 2 neuraxial approaches? (LT, CCTTTL)
- is a neuraxial block necessary for a laparoscopic approach?
- lower thoracic, caudal catheter threaded to thoracic level
- no
myelomeningocele:
- AKA for this? (SB)
- what 2 things do not close at birth? (B, SC)
- these pts often have neurogenic dysfunction of what 2 things? (B, B)
- do these pts get neuraxial anesthesia?
- spina bifida
- backbone, spinal canal
- bowel, bladder
- no
myelomeningocele:
- what 2 procedures require GETA d/t longer procedure length? (MA, MACE)
- what 3 procedures are okay to get an LMA d/t shorter procedure length? (C, BBI, V)
- these pts often have what malformations? (CM)
- these malformations are associated with what 2 things? (H, CSA)
- mitrofanoff appendicovesicostomy, malone antegrade continence enema
- cystoscopy, bladder botox injection, vesicostomy
- chiari malformations
- hydrocephalus, central sleep apnea
chiari malformations are brain tissue extended into where?
spinal cord
sexaual development disorders definition:
a heterogenous group of conditions characterized by aberrant what, what and/or what with widely varying what 2 types of manifestations? (C, G, AS; G,P)
chromosomal, gonadal and/or anatomic sex; genotypic and phenotypic
sexaual development disorders:
- these can affect the production of what meaning these pts may need a stress dose of what? (C, S)
- these disorders are associated with anomalies in what 3 areas? (S, C, A)
- are these pts genotypically and phenotypically correct?
- is this the same as transgender?
- cortisol, steroids
- spinal, cardiac, airway
- no
- no
Testicular torsion:
- children with acute testicular torsion should be considered “an acute abdomen” requiring what type of intubation and to be intubated with what?
- do these pts need aggressive treatment for pain once the surgery is over?
- RSI, endotracheal tube
2. no
Wilms tumor:
- arise from persistent immature what renal tissue? (P)
- 80% of the children present in what age range?
- what are the 2 words to describe the anticipated blood loss for the tumor removal? (M, R)
- is adequate blood warming capability mandatory?
- pts with this tumor can have issues with what making an epidural block not an option?
- parenchymal
- 1-5 years
- massive, rapid
- yes
- coagulation
peniles procedures:
- what type of block are great for these procedures?
- what is hypospadias?
- for outpatient procedures, what 2 blocks can the children receive?
- more extensive hypospadias that require longer surgeries require what 2 types of airways?
- caudal
- malpositioned urethral meatus
- penile, caudal
- LMA, ETT
block in general:
- laparoscopies require what type of block technique?
- open procedures require what type of block technique?
- single shot
2. catheter
caudal block for penile procedures:
- for procedures longer than 4 hours, what concentration of LA at beginning and end?
- for procedures that are 3-4 hours, what concentration of LA at beginning and end?
- what is the mL/kg of LA?
- 0.2% ropivacaine with epi
- 0.1% ropivacaine with epi
- 1 mL/kg
will she do a caudal on an 8 or 9 year old who is very slender at 20-30 kg for genital procedures?
yes
what LA provides a motor blockade?
0.375% ropivacaine with epi
what 2 LAs block sensory without significantly blocking motor?
bupivacaine 0.125% with epi, ropivacaine 0.2% with or without epi
testicular torsion:
- majority of testes saved if surgery within how many hours?
- are these considered a full stomach?
- are neonates still considered a full stomach?
- a caudal can be performed for this, but what is the limiting factor for doing a one? (T)
- after the torsion is relieved, do these pts need a much narcotics?
- 6 hours
- yes, RSI
- yes
- time
- no
what 2 pts require RSI? (SH, TT)
- strangulated hernia
2. testicular torsion
cloacal anomaly:
- definition: collection of defects during what development? (F)
- more common in boys or girls?
- girls present with what 3 things converged together called a “cloaca”? (U,V,R)
- the most severe/complicated cloacal anomaly involves what? (BE)
- fetal
- girls
- urethra, vagina, rectum
- bladder exstrophy
bladder exstrophy:
- therapy is aimed at surgical reconstruction of what and preservation of what function? (B, R)
- surgical goal is to close what 3 things? (B, PU, AW)
- what type of osteotomy facilitates surgical closure and decreases stress on the midline incisions? (BIO)
- are these peds at risk for multiple procedures?
- bladder, renal
- bladder, posterior urethra, abd wall
- bilateral iliac osteotomy
- yes
bladder exstrophy:
- bilateral iliac osteotomy may be done in conjunction with what other service?
- parents and child who come multiple times for these procedures like the same what each time? (R)
- by having really good pain control with these peds, what are you trying to prevent?
- as the child becomes a toddler, what should you discuss with the parents?
- orthopedics
- routine
- fear of coming to the hospital
- pre-med
Anesthesia for bladder exstrophy and cloacal repairs:
- assess what 2 things with genetic anomalies? (C, A)
- can have S/S of what 2 things? (RI, ED)
- considered a hi risk for fluid loss d/t exposed what? (V)
- talk with surgical team regarding fluid resuscitation with what 3 products? (BSS, C, BP)
- cardiac, airway
- renal insufficiency, electrolyte disturbances
- viscera
- balanced salt solution, colloid, blood products
Anesthesia for bladder exstrophy and cloacal repairs:
- should IV access be above or below surgical site?
- at risk for what? (H)
- what should be considered for post-op pain?
- what 3 IV accesses do you want?
- above
- hypothermia
- epidural catheter
- 1 large bore IV, art line, and another PIV or central line
Anesthesia for bladder exstrophy and cloacal repairs:
- what is anesthesia plan?
- how many hours do you run epidural for?
- what is bupivacaine epidural mg/kg/hr?
- what is lidocaine epidural mg/kg/hr?
- GETA with narcotics and/or regional
- 48 hours
- 0.2 mg/kg/hr
- 0.8 mg/kg/hr
are peds at increased or decreased risk for LAST?
increased
Anesthesia for bladder exstrophy and cloacal repairs:
- what type of induction is preferred?
- is RSI needed?
- is there time to resuscitate the pt before doing these surgeries?
- what are 3 reasons these surgeries put pt at risk for hypothermia? (LP, PL, PC)
- IV
- no
- yes
- lithotomy position, procedure length, position changes
What do these procedures allow for:
- mitrofanoff appendicovesicostomy
- malone antegrade continence enema
- abdominal self catheterization for urine
2. abdominal self enema administration to facilitate bowel continence