Week 2 urologic procedures Flashcards
Why is it important to find out a babies gestational age?
Premises Have a higher risk for SIDS and anesthesia complications
What is included in upper urinary tract?
Ureter and kidney
What is included in the lower urinary tract?
Bladder, prostate, and urethra
What are 5 common nerve injuries with urologic procedures?
- Common peroneal; 2. Saphenous nerve; 3. Sciatic nerve; 4. Obturator nerve; 5. Femoral nerve
What position are urologic procedures usually performed in?
Lithotomy
How does common peroneal nerve get injured?
Compression of fibular head on leg brace
How does saphenous nerve get injured?
Compression of MEDIAL tibial condyle
How does sciatic nerve get injured?
Excessive external rotation of legs & excessive extension of the knees
How does obturator nerve get injured?
Excessive flexion of the groin
How does Femoral nerve get injured?
Excessive flexion of the groin
What is the average amount of blood in each leg?
500 mL
What is the obturator reflex and what can happen?
Obturator nerve stimulation by electrocautery leads to adductor muscle contraction which can lead to bladder rupture during urologic procedure
What procedure has an increased risk of obturator reflex occurring?
Resecting lateral wall tumors with electrosurgical resection
What happens during cystoscopy? What type of anesthesia is used?
Passage of rigid scope through the urethra — general or regional anesthesia
If using regional anesthesia for cystoscopy, what sensory level must be attained?
T9-T10 or T8 for ureters
Where are sympathetic and motor anesthesia levelsin relation to the sensory level?
Sympathetic is 2 levels up and motor is 2 levels down
Why should TURBT patients be paralyzed?
Coughing or straining puts that at higher risk for bladder perforation
What about regional anesthetisia puts TURBT patient at higher risk of bladder perforation?
Bladder becomes atonic and may be come thinner when distended
If bladder perforation occurs what can awake patient experience (3)?
- Shoulder discomfort; 2. Nausea; 3. Vomiting
What is pt at risk for if bladder perforation occurs with malignancy present?
seeding into the peritoneum
What are the 3 main things pts are at risk for if bladder perforation occurs?
- Blood loss; 2. Hypothermia; 3. Bacteremia
What are clinical indicators of bladder perforation?
HTN and tachycardia followed by severe hypotension; reduction of irrigation fluid return is early sign
What is DIC triggered by during bladder irrigation?
Prostatic throbogenic substances - especially with cancer of prostate
What is required with bladder perforation?
Emergent subrapubic cystostomy or possible exploratory lap
What are 4 requirements of irrigation solution for TURP?
- Clear; 2. Nonconductive; 3. Non-hemolytic; 4. Nontoxic
What spinal level is needed for TURP?
T10
Why is spinal anesthesia preferred for TURP?
- Bladder will be atonic with large capacity; 2. Post op bladder spasm prevented (homeostasis); 3. Awake pts can supply early detection of complications
What are 2 complications of TURP?
- Blood loss; 2. Venous absorption of irrigation fluid
What are 2 early signs of TURP syndrome?
Hypertension and tachycardia
How can blood loss be estimated during TURP case?
2-5 mL/min of resection time
What may an awake pt complain of if experiencing TURP syndrome?
Dyspnea and nausea
Where is irrigation fluid absorbed into body during TURP?
Open venous sinuses of prostate
