ESRD Flashcards
What concerns do you have about providing anesthesia to an ESRD patient?
- electrolyte abnormalities (hyperK, hypoCa, hyperglycemia)
- metabolic acidosis
- cardiac conduction blockade
- CHF
- bleeding (uremia causes impaired vWF causes impaired PLT function)
- altered drug clearance
what ways do you treat hyperK?
- calcium
- glucose/ insulin
- B-2 agonist
- hyperventilation
- bicarbonate
What do you do if someone has a transplanted kidney and you need to give blood?
- try to avoid
- exposure to leukocyte antigens cause alloantibodies
- washed (leuko-reduced), irradiated (less GVHD), CMV negative
What drugs have prolonged clearance in ESRD pts?
- pancuronium
- atropine, glyco
- ketamine
- morphine
- benzos
- meperidine
ESRD pt needs hemicolectomy. How would you do fluid replacement?
- avoid fluid overload
- limit replacement to 1-2cc/kg/hr
- replace blood using blood/colloid, not 3:1 fluids
Often times heparin is used during dialysis, how long after heparinization do you need to wait for neuraxial intervention?
- wait 4-6hrs after NA before hep in HD
- when removing, make sure removal is at least an hour before heparinization in HD
For UFH, how long do you wait if SQH 5,000 U (for NA placement)? What about 7.500 U? 10,000 U?
5000U = wait 4-6hrs before NA
the effect of UFH takes 1hr to kick in
7500U = 12hrs
> 10,000U = 24hrs
How long do you wait for NA if hep gtt stopped?
- wait 4-6hrs after heparin has been stopped
- after epidural placed or removed, wait 1hr until restarted
for LMWH how long do you wait for NA if low dose? high dose?
low dose = 12hrs
high dose = 24hrs
if LMWH for 4days+ check PLT for HIT
How long o you wait for NA if on Xa agent? Rivaroxiban, apixiban, edoxaban, betrixaban?
wait 72hrs (3 days)
How long o you wait for NA if on direct thrombin inhibitor? Argatroban? Dabigatran?
delay for 72 to 120hrs depending on Cr clearance
monitor aPTT
How long o you wait for NA if on clopidogrel?
wait 5- 7 days
