Effects of Anesthesia and sx on Renal fx-Josh Flashcards Preview

BioScience II > Effects of Anesthesia and sx on Renal fx-Josh > Flashcards

Flashcards in Effects of Anesthesia and sx on Renal fx-Josh Deck (43):
1


Effects are typically less w/ _____ vs _____ anesthesia


less w/ Regional vs General

2


anesthesia put ______ decreases in RBF, GFR, urininary flow, and Na+ excretion


Reversible

3

Most renal changes from anesthesia are not direct but mediated by ____ and _____ influances


autonomic and hormonal influences

4


Anesthesia and Surgery effects on Renal Fxn:

Most changes can be partially overcome by maintaing what?


adequate intravascular volume and Normotension

5


Anesthesia and Surgery effects on Renal Fxn:

there are very few anesthetics we administer such as _____ and ____ which in high doses can potentially cause specific renal toxicity


enflurane

Sevoflurane (it got all those F's)

6


Anesthesia and Surgery effects on Renal Fxn:

Most inhalation and IV drugs cause some degree of cardiac depression and/or vasodilation and can decrease ____ ____


Arterial BP (thus decreasing RBF)

7


Anesthesia and Surgery effects on Renal Fxn:

how does regional anesthesia effect RBF?


sympathectomy

8


Anesthesia and Surgery effects on Renal Fxn:

decreases in BP below the level of autoregulation can ultimately decrease what 4 things?

 

  1. RBF
  2. GFR
  3. Urinary flow
  4. Na+ excretion

9


Anesthesia and Surgery effects on Renal Fxn:

some neural effects such as sympathetic activation (from light anesthesia) can increase renal vascular resistance and activate hormonal systems. both tend to decrease what?


GFR

RBF

UOP

(remember you'll never stop to take a piss if being chased by a man eating Lama)

10


Anesthesia and Surgery effects on Renal Fxn:

endorine effects:

Stress responce related to surgical stimulation, CV depression, Hypoxia, or acidosis, all will cause an increase in catecholamines, ADH, and AT II. ALL that will reduce RBF how?


by induducing renal artery constriction

and aldosterone enhances Na+ reabsorption

11


Anesthesia and Surgery effects on Renal Fxn:

how does Pneumoperitoneum or PEEP effect renal system

 

  • Abdominal compartment syndrome like
  • d/t renal vein and vena cava compression
  • leads to an increased renin, aldosterone, and ADH release

12


Anesthesia and Surgery effects on Renal Fxn:

how does CPB effect the renal system


Non oulsatile flow

production of free radicals

decreased renal perfusion at cross clampt ime

13


Anesthesia and Surgery effects on Renal Fxn:

how does pelvic sx effect the renal system?


compression of the bladdder by retractors

Ligation of ureters

trendelenburg position impeding emptying of bladder

14


Anesthesia and Surgery effects on Renal Fxn:VAA

release of Fluride Ions from VAA metabolic degradation w/ plasma comcentration > _______ have been associated w/ renal toxicity?


> 50 micromol/L

15


Anesthesia and Surgery effects on Renal Fxn:VAA

floride production is negligible w/ halothane, desflurane, and iso, but the greatest w/ prolonged use of ____ and especially ____


enflurane

Sevoflurane

16


Anesthesia and Surgery effects on Renal Fxn:VAA

as we know in Lab rate ONLY sevo at low flows can produce _____ ____ which can cause renal damage?


Compound A

17


Anesthesia and Surgery effects on Renal Fxn:VAA

overall b/c of low metabolism/kidney excretion VAAs may be the ______ anesthetic for pts w/ impaired renal functions?


Safest

(found this very interesting)

18


Anesthesia and Surgery effects on Renal Fxn: IV agents

which drugs inhibnit prostaglandin sysnthesis preventing the renal production of vasodilatory prostaglanding in pts with high levels of ATII and Norepinephrine


NSAIDS

19



Anesthesia and Surgery effects on Renal Fxn: IV agents

what drugs block the protective effects of AT II and may result in additional reductions in GFR during sx


ACE inhibitors

20



Anesthesia and Surgery effects on Renal Fxn: IV agents

what other drugs cause renal artery vasospasms, direct cytoxic injury or renal/tubular obstruction?


Aminoglycosides

Immunosuppresive agents

Radiocontrast dyes

21



Anesthesia and Surgery effects on Renal Fxn:

W/ aortic cross clamping regardless where the position of the clamp is RBF is decreased ____%


50%

22


Anesthesia and Surgery effects on Renal Fxn:

release of the cross clamp causes an increase in RBF, but GFR is impaired to only 2/3 of normal for up to how long


24 hrs

23

manifestations of Renal Failure:

what electrolytes/ cells are increased in renal failure?


K+

Phasphate

Mg

Uric acid

24


manifestations of Renal Failure:

what electrolytes/ cells are decreased in renal failure?


Ca++

Albumiin

RBC production

25


manifestations of Renal Failure:

what happens to CO in response to decreased O2 carrying capacity, by means of Na+ retention on RAAS


Increases

26


manifestations of Renal Failure:

the increased sytemic HTN leads to what?


LVH

27


Fluid management:

avoid what w/ hyperkalemic pts?

 


LR

28



Fluid management:

use _____ free solutions?


glucose free

29



Fluid management:

blood loss shpould generally be replaced w/ what?


PRBCs

30


Electrolyte disturbances:

normal Na+


135-145 mEq/L

31



Electrolyte disturbances:

serious manifestation of hyppoNa+ are generally associated w/ plasma Na+ concentrations of what?


<120 mEq/L

32



Electrolyte disturbances:

plasma concentrations of Na+ > what are generally safe for GA


>130 mEq/L

33



Electrolyte disturbances:

why should you caution rapid correction of hyponatremia?


b/c it has been associated w/ demyelinated lesions in the pons resulting in serious permanent neurological condictions

34


Electrolyte disturbances:

HyPERnatremia _____ the MAC for inhaled anesthetics in animal studies?


increases

35



Electrolyte disturbances:

electrive procedures should be postponed in pt's w/ significant hypernatrema > ______


> 150mEq/L

36



Electrolyte disturbances: Potassium

normal levels?


3.5-5 mEq/L

37


Electrolyte disturbances: Potassium

what do you want to avoid in cases of high K+


LR

Resp acidosis

38


Electrolyte disturbances: Potassium

what causes hypoK+


diuresis

antibiotic

NGT

insulin

Acute alkolosis

39


Electrolyte disturbances: Potassium

what causes hyperK+


rhabdomyolysis

SCh

renal failure

K sparing diuretics

ACE inhibitors

NSAIDS

40


Electrolyte disturbances: Calcium

normal value for ionized

 


1.1-1.4 mmol/L

41


Electrolyte disturbances: Magnesium

Normal values

1.7-2.1 mEq/L

42


What is TURP syndrome/ how does it occur?

 

  • Prostate tissue is resected and large amounts of irrigation are used
  • Eectroltye solution can NOT be used d/t cautery, thus slightly hypotonic/non-electrolyte solution are used
  • Open venous sinuses in the prostate and ressure of irrigation fluid allow systemic absorption of the irrigation fluid (2L or more)
  • can present intraop or post op
  • monitor Na+ levels

43


whoo enough fucking renal


&*&%^% that sucked