Exam 2 - Kidney/Liver Considerations Flashcards
(21 cards)
what parameters should you consider for renal disease
azotemia - BUN, Cr
USG
systemic hypertension
anemia
hyperkalemia
metabolic acidemia
uremia
how can you prepare a patient with renal dz for anesthesia
prevent hypovolemia - IV crystalloids
recheck bloodwork/electrolytes
correct anemia (prevent decrease O2 delievery)
recommended premeds for a patient with renal disease
opioids - min CV depression, potent sedation/analgesia, not renal eliminated
+/- benzodiazepine - min CV effects
+/- anticholinergics - prevent bradycardia induced decreased CO
what premeds to avoid in patients with renal dz
alpha-2 agonists - vasoconstriction, bradycardia
acepromazine - vasodilation/hypotension
what induction drugs should you use for renal disease patients
propofol or alfaxalone
NO inhalants
NO ketamine in cats
what maintenance drugs do you use in patients with renal dz
inhalants (isoflurane, desflurane)
NOT sevoflurane - compound A is nephrotoxic
what post-op meds should you avoid in renal disease patients
NSAIDs (meloxicam, carprofen)
what do you want to monitor in a patient with renal disease
ECG, Spo2, temp
invasive BP measurement
urine output
what is the preferred diuretic for renal disease patients
mannitol
what fluids do you want to give renal disease patients
IV crystalloids
how can you increase urine output in a cat and a dog
cat - fenoldpam
dog - low dose dopamine
what parameters are especially important in cats with urethral blockage
hyperkalemia
acidemia
post-op diuresis
how do you treat hyperkalemia
calcium gluconate
bicarb
insulin/dextrose
what parameters to check for liver disease patients
ALT, AST, GGT
ALP
total bili
albumin
glucose
clotting factors
how would you treat a coagulopathy in a liver disease patient
fresh frozen plasma
cryoprecipitate
what premeds are recommended for liver disease patients
opioids - min CV effect, reversible, min metabolism
benzo (midazolam) - min CV effect, reversible
what premeds to avoid in liver disease patients
alpha-2 agonist - vasoconstriction/bradycardia
acepromazine - vasodilation/hypotension, metabolized by liver
ketamine - not reversible, metabolized by liver, long duration
induction drugs for liver disease patients
propofol/alfaxalone - redistribute, propofol uses extrahepatic sites
avoid ketamine & inhalants
maintenance drugs for liver disease patients
inhalants (not halothane)
reduced doses for protein bound drugs (lidocaine) due to risk of seizures
what do you want to especially monitor in a patient with liver disease
glucose
what fluids will you give to support liver patients
IV crystalloids + colloids to maintain oncotic pressure
colloids + fresh frozen plasma
