APA 2 - Anesthesia for Urologic Procedures

Question 1

Urologic endoscopy is performed to visualize and evaluate the upper and lower urinary tracts to diagnose and treat conditions such as

Answer 1

hematuria, pyuria, calculi, trauma, cancer

Question 2

Upper urinary tract

Answer 2

ureter and kidney

Question 3

lower urinary tract

Answer 3

bladder, prostate, urethra

Question 4

Nerve injuries are a concern for these types of patients because they’re in the lithotomy position. What nerves are at risk?

Answer 4

common peroneal, saphenous, sciatic, obturator, femoral

Question 5

Compression of the fibular head on the leg brace can result in injury to what nerve?

Answer 5

common peroneal

Question 6

Compression of the tibial condyle can result in injury to what nerve?

Answer 6

saphenous nerve

Question 7

Excessive external rotation of legs and excessive extension of the knees can result in injury to what nerve?

Answer 7

sciatic nerve

Question 8

Excessive flexion of the groin can result in injury to what nerves?

Answer 8

obturator and femoral

Question 9

When lowering the legs from the lithotomy position what may happen?

Answer 9

BP fall

Question 10

Bladder rupture/injury secondary to ADDUCTOR muscle contraction from _______ ________ stimulation from electrocautery

Answer 10

obturator nerve

Question 11

When is there an increased risk of Obturator reflex from stimulating the obturator nerve?

Answer 11

When resecting lateral wall tumors

Question 12

________is passage of a rigid scope through the urethra

Answer 12

cystoscopy

Question 13

Can a cystsocopy be done with 2% lidocaine jelly?

Answer 13

apparently yes

Question 14

Urethral stimulation, dilation and distention of bladder can be painful requiring _____ or _______ anesthesia

Answer 14

general or regional

Question 15

If regional anesthesia is chosen for a cystoscopy, a ___ to ___ sensory level is required and ___ for ureters

Answer 15

T9-T10 / T8

Question 16

Review dermatome man on slide

Answer 16

16

Question 17

Cystoscopy for retrograde ureteral catheterization is used for what?

Answer 17

to visualize the ureter and kidney, to place stents, to drain obstructions, to remove renal calculi

Question 18

TURB

Answer 18

Transurethral resection of the bladder

Question 19

TURB is where endoscopic resection and electrodesiccation are used to treat ________ __________ tumors

Answer 19

superficial bladder

Question 20

What kind of anesthesia for a TURB and why?

Answer 20

General anesthesia - no coughing or straining wanted b/c increases risk of bladder perforation

Question 21

If using regional anesthesia for a TURB, the bladder becomes ________ and may become thinner when ________, increasing the risk of _______

Answer 21

atonic / distended / perforation

Question 22

If doing a TURB on an elderly person, ________ is better than general

Answer 22

regional

Question 23

S/S of bladder perforation in the awake patient

Answer 23

If periotneal cavity entered will have shoulder discomfort, Nausea, vomiting

Question 24

If a high-grade malignancy present and the bladder is perforated there is a risk of what as it relates to the cancer?

Answer 24

seeding the cancer cells into the peritoneum

Question 25

Blood loss and bacteremia can also happen from a _____ _____

Answer 25

bladder perforation

Question 26

Lavaging the bladder can result in ________, especially if perforated

Answer 26

hypothermia

Question 27

The awake patient will experience _______ fullness, ________ spasm and PAIN with a bladder perforation

Answer 27

suprapubic / abdominal

Question 28

______ and _____ are early signs of bladder perforation followed by SEVERE ________

Answer 28

HTN / Tachycardia / HYPOTENSION

Question 29

Cool irrigation causes ___________ and results in systemic cooling. ____ _______ will decrease this risk

Answer 29

vasoconstriction / warm fluids

Question 30

______ is a risk which is triggered by release of prostatic thrombogenic substances - especially with cancer of prostate

Answer 30

DIC

Question 31

Have to be prepared to convert to an _____ _____

Answer 31

open procedure

Question 32

TURP

Answer 32

Transurethral resection of the prostate

Question 33

For a TURP, ______ or ______ prostate tissue is removed by electrosurgical resection under direct endoscopic vision

Answer 33

neoplastic / obstructive

Question 34

TURP is performed by application of a high-frequency current to a wire loop. Hemostasis is achieved by sealing the vessels with the _________ current

Answer 34

coagulation

Question 35

An optically clear, nonconductive, nonhemolytic, nontoxic solution is required to _______ the bladder for a TURP

Answer 35

distend

Question 36

TURP general anesthesia considerations

Answer 36

coughing must be avoided b/c it increases the risk of bleeding

Question 37

What anesthesia is preferred for TURP

Answer 37

spinal

Question 38

What are the benefits for doing a spinal for TURPs?

Answer 38

the bladder will be atonic with a large capacity and thus glycine infusion pressure can be low, emptying less frequent which fascilitates resection. Post-op bladder spasm is prevented allowing for hemostasis. AWAKE PATIENTS MAY SUPPLY EARLY DETECTION OF COMPLICATIONS

Question 39

Complications of TURP

Answer 39

Blood loss and venous absorption of irrigation fluid

Question 40

Early signs of venous absorption

Answer 40

hypertension and tachycardia

Question 41

With venous absorption, CVP may rise as cardiac ________ occurs. The awake patient may complain of ______ or ________. Hypoxia and/or Hyponatremia causes ______ syndrome

Answer 41

decompensastion / dyspnea and nausea / TURP

Question 42

TURP syndrome is AKA

Answer 42

Water intoxication or Glycine Toxicity

Question 43

The awake patient may exhibit as a result of TURP syndrome

Answer 43

apprehension, disorientation, convulsions, coma

Question 44

Glycine disadvantages

Answer 44

Risk of blindness or post op visual impairment, less likelihood of TURP syndrome

Question 45

Sorbitol disadvantages

Answer 45

less likelilhood of TURP syndrome but can cause hyperglycemia and lactic acidosis

Question 46

Mannitol disadvantages

Answer 46

nonmetabolized, osmotic diuresis which causes hypervolemia

Question 47

Treatment for TURP syndrome

Answer 47

Ask surgeon to control bleeding and finish surgery fast, send blood sample for Sodium level (less than 120 mEq/L is serious), correct hypervolemia and hyponatremia with fluid restrictions and diuretics (furosemide 10-20 mg), correct hyponatremia with hypertonic solutions cautiously, NS or LR will postpone if sodium level is less than or equal to 125

Question 48

With an open prostate radical prostatectomy what is seen in 50% of patients

Answer 48

impotence

Question 49

Position for a suprapubic (retropubic) approach for a radical prostatectomy

Answer 49

supine, flex table , trendelenburg

Question 50

Position for a perineal approach for a radical prostatectomy

Answer 50

extreme lithotomy position

Question 51

Which approach has more hemorrhage for radical prostatectomy

Answer 51

Retropubic

Question 52

With radical prostatectomy, blood loss occurs during control of ____ _____ _____

Answer 52

dorsal venous complex (get up and look at suction)

Question 53

Radical prostatectomy can be done under regional or general anesthesia but regardless, a large _____ is a must

Answer 53

IV

Question 54

During a radical prostatectomy what diagnosistic dye can cause hypotension and drop your oxygen saturation?

Answer 54

methylene blue (can cause sat to go to 65% for 1-2 minutes)

Question 55

Indigo carmine dye has an alpha sympathomimetic effect to increase ____

Answer 55

BP

Question 56

Indications for nephrectomy

Answer 56

chronic infection, trauma, cystic or calculus disease, neoplasm

Question 57

A nephrectomy is perfromed by _____ _______ or _____ _____ incicsion

Answer 57

lateral retroperitoneal / anterior abdominal

Question 58

For nephrectomy you will be using a _____ flex table and KIDNEY BAR which may cause vena cava ______ and _______. General or combined general with regional anesthesia is used for this surgery

Answer 58

lateral / compression / hypotension

Question 59

Considerations prior to renal transplant

Answer 59

optimize prior, serum potassium should be normal, metabolic acidosis should be corrected, Anemia is common

Question 60

Renal transplant position

Answer 60

supine with roll under hip

Question 61

For renal transplant IV access should not be on the same side as the ______

Answer 61

fistula

Question 62

What muscle relaxer for renal transplant?

Answer 62

atracurium

Question 63

For a renal transplant, regional anesthesia is contraindicated by preexisiting __________ and or ___________

Answer 63

coagulopathy / immunosuppression

Question 64

You want what fluids for renal transplant?

Answer 64

NS. Avoid LR and K+

Question 65

Adequate hydration is critical for renal transplants, so cyrstalloid, colloid, and blood should be used for _____________ of the kidney

Answer 65

revascularization

Question 66

With renal transplant, ______ ______ and ________ help discourage rejection and diuresis

Answer 66

methyl prednisone / diuretics

Question 67

With renal trasnsplants, low dose _______ used if oliguric

Answer 67

dopamine

Question 68

3 major complications of kidney transplant

Answer 68

hyperkalemia, delayed renal function, graft failure

Question 69

Cold storage solutions are used to preserve kidney graft survival and minimize tissue necrosis and edema. ____ degrees celsius is goal to reduce _______ demands

Answer 69

4 / metabolic

Question 70

Continuous perfusion of the kidney causing pulsatile flow of cold perservation is pumped at ___ to __ mmHg.

Answer 70

40 to 60

Question 71

What is in the solution for cold preservation of kidney?

Answer 71

glucose, potassium, magnesium, ABX, HC03, and heparin (which can trigger hypersensitivity reaction in recipient)

Question 72

POPS

Answer 72

Portable Organ Preservation System (has changed time frame from 48 hrs to 72 hrs)

Question 73

Anesthetic considerations for Radical Cystectomy

Answer 73

Done in supine position, general or combined anesthesia, arterial and CVP, Large IV, Fluid shifting can be extensie and unable to monitor urine so need the CVP, diuretics may be needed to stimulate output, indigo carmine or methylene blue used at times

Question 74

Complications of Radical cystectomy

Answer 74

hypothermia, inadequate fluid replacement, need for post-op ventilation

Question 75

What sensory level block needed for orchiectomy and urogenital plastics procedures?

Answer 75

T9

Question 76

A/V shunts and fistulas are placed for dialysis access. Patient lies in ______ postion with arms ________. General, regional and local infiltration are all acceptable. Can do these as MAC as well. Their blood pressure are very _______.

Answer 76

supine / extended / labile

Question 77

ESWL

Answer 77

Extracoroporal Shock Wave Lithotripsy

Question 78

ESWL breaks ________ urinary tract stones with external shock waves. Cushion the interface with skin or patient is submerged in a tank of water.

Answer 78

upper

Question 79

With ESWL, the shock delivered is triggered by the _____

Answer 79

QRS

Question 80

With ESWL, there will be stents placed as well usually so the patient will need to be in the _______ position for that.

Answer 80

lithotomy

Question 81

After ESWL, adequate _______ and __________ help pass stone fragments

Answer 81

hydration / diuretics