Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Liver Kidney + Transplant Anesthesia > Kidney + Transplant Anesthesia > Flashcards

Kidney + Transplant Anesthesia Flashcards

(65 cards)

Start Studying
1
Q

At what spinal level is the center of the kidneys?

A

Retroperitoneal at L2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RBF

A

~1L/min = 20-25% of Cardiac Output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why would placing ice packs over the kidneys for rapid cooling be so important?

A

Kidneys have high cardiac output = cools more quickly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does blood enter the glomerulus

A

Afferent arteriole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does blood from the kidney enter circulation

A

Efferent Arteriole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What part of the kidney hold 85% of the nephron function

A

Cortical = excrete & regulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which part of the nephron holds 15% of nephron function

A

Juxtamedullary = concentrate & dilate urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A mean arterial pressure (MAP) less than _______ causes filtration to cease?

A

MAP <60
-Afferent arteriole vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does neural sympathetic stimulation affect RBF?

A

Activation of the SNS decreases RBF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does neural parasympathetic nervous system stimulation affect the kidneys?

A

No change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Renal hormones (6)

A

-Aldosterone, ADH, Angiotensin, Atrial Natriuretic Factor, Vitamin D, Prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Renal regulation of Acid-Base Balance

A

Countercurrent multiplication = concentration & dilution of urine
-Coming from vasa recta or LOH/Collecting duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

COLT PA

A

1.Carbonic Anhydrase inhibitors = PCT
2. Osmotics = descending limb of LOH
3. Loop Diuretics = Ascending LOH
4. Thiazides = Early DCT ???
5. Potassium Sparing = Late DCT & CD
6. Aquaporins = collecting duct ???

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

GFR

A

quantity/how much filtrate is formed each minute in all nephrons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Juxtaglomerular Complex Function

A

Regulates GFR & Secretes Renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ultrafiltration

A

Fluid & soluble material into Bowman’s capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Proximal Convoluted Tubule

A

**Reabsorbs Na the most
-Reabsorption of filtrate (Na)
-2/3 salt & water
-100% organic solutes = glucose & AAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The Descending limb of LOH, _________________ urine

A

Descending limb concentrates urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The Ascending limb of LOH is___________ to water, ___________ to ions & urea = hypertonic filtrate

A

-Permeable to water
-Impermeable to ions & urea
=Hypertonic filtrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The DCT is __________ to water, ________ to ions = hypotonic filtrate.

-Opposite of Ascending Limb

A

-Impermeable to water
-Permeable to ions
=Hypotonic filtrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Atrial Natriuretic Peptide (ANP)

A

-Senses atrial stretch/overload leading to cascade

-Inhibits renin & aldosterone secretion –> antagonizes Na retention –> dilates afferent arterioles & increases GFR –> systemic vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Prostaglandins do what to the afferent arteriole?

A

-PG vasodilates afferent arteriole in golmerulus
-Maintain hemodynamics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Direct anesthetic alterations of kidney

A

-RVR + RBF, GFR, Tubular function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Indirect anesthetic alterations of kidney

A

*Circulatory, endocrine, or SNS changes
-Decreased CO –> activates SNS = increased RVR, ADH secretion causing vasoconstriction of afferent arterioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What anesthetic drugs are associated with catecholamine release?
Volatiles= all 3
26
What volatile agent has been shown to break down into Compound A at low flows?
SEVO. Keep flows >2L
27
Why avoid meperidine in renal patients?
Active metabolite can cause seizures & is not removed by dialysis
28
Atropine & robinul in renal patients
Decrease dose d/t reduced protein binding
29
Important to check/verify and document when using regional anesthesia
Neuropathies, especially in the legs -Greater risk of getting motor blockade
30
Regarding regional anesthesia, renal patients have an increased risk of developing this severe medication reaction
LAST (acidosis)
31
Intralipids dose
20% intralipids *1.5 mL/kg (LBM) over 1 minute. Repeat bolus 1-2x for persistant CV collapse *0.25mL/kg/min over 20min infusion -Increase up to 0.5mL/kg/min for refractory HoTN -Continue infusion for at least 10min after attaining circulatory stability
32
IV drugs & renal patients
Variable often d/t increased Vd, decreased protein binding, low pH
33
Sodium Thiopental & renal patient
AVOID! Exaggerated Effect 75-85% bound to albumin
34
Propofol & renal patient
Safe for induction/maintenance -No accumulation
35
Ketamine & renal patient
AVOID -Detrimental increase in BP & CO ***Accumulation
36
Narcotics & renal patient
exaggerated effects -Remi = not dependent on renal function for elimination (plasma esterases) -Dilaudid = hydromorphone-3-glucuronide accumulates
37
Volatile Anesthetics & renal patient
-Do not rely on kidney function for elimination -Avoid reductions in CO -SEVO & compound A -Fluoride nephrotoxicity level of 50 umol
38
Succinylcholine raises serum potassium levels by approximately .....
0.5 mEq/L
39
Vecuronium & renal patients
Excreted renall & prolonged 30%
40
Rocuronium & renal patients
May be prolonged
41
Be mindful of ___________ during renal artery anastomosis etc.
Bleeding
42
What is the most common indication for renal transplantation?
Type II DM
43
Recipient of renal transplant must have normal coags & ineffective production of ....
Ineffective production of Factor 8 + vWF
44
What is harvest organ preservation & ischemic time goal?
Less than 30min -Diuresis begins quickly
45
Donor may have this vasoactive & renal protective medication infusing
Dopamine 1-3 mcg/kg/min
46
T/F = renal patients typically have gastroparesis
True -Give lower dose Reglan (H2 antagonist)
47
Fluids for renal patients
Conservative management with NS +/- dextrose. -Consider Plasmalyte
48
You do not want to treat/manage preop HTN because it could effect the kidneys... T/F
F -Treat/manage preop HTN
49
Outside of GETA, what other anesthetic techniques could be used for renal transplant
Epidural for postop pain management
50
Induction of anesthesia w/ propofol in renal transplant patient
RSI with Higher induction dose of propofol d/t anemic + hyperdynamic state
51
Remifentanil metabolite
Can accumulate in ESRD even though metabolized by plasma esterases
52
Volatile agents for renal transplant
ISO = skeletal muscle relaxant, minimal metabolism, N2O
53
What does mannitol & furosemide facilitate during renal transplant?
Urine output & reduction in tissue & intravascular volume
54
Blood glucose control goals for renal transplant
Tight control: 80-110 mg/dL
55
High alert when release of clamp during renal transplant surgery. Why?
Cardiac arrest can occur when release of clamp
56
Special attention to _______, ________, ________ , and _________ regiments with immunosuppressants
Sterile technique Antibiotic Antifungal Antiviral regiments
57
Tacrolimus used with adrenal corticosteroids increase risk of.....
Anaphylaxis
58
Tacrolimus (Prograf) metabolism etc
-CYP450 -Causes up regulation -Nephrotoxic : used with cyclosporine -1st does w/in 24hr of transplant
59
Adverse effects of mycophenolate (Cellcept)
GI, Heme, HTN, HLD, Ischemic vascular disease, tremors, nephrotoxic
60
When can Mycophenolate (Cellcept) be given with renal transplant?
Not until renal allograft function has reduced creatinine level to 1/2 of admission value
61
How does mycophenolate affect neuromuscular blockade
Enhances neuromuscular blockade produced by atracurium
62
Transplant patient for nontransplant surgery
-Abx, antiviral, antifungal & immunosuppressants not messed with -Renal fxn & choice of neuromuscular blocker important! as well as Abx & other drugs -Maintain renal perfusion & adequate volume replacement = CVP monitoring ***AVOID NSAIDS
63
Transplant patient presents for surgery w/ signs of acute rejection or infection.... what do you do?
May benefit from delay and given time to optimize
64
Lung transplant pt for non-transplant surgery
-Tracheal anastomosis, denervation below suture, diminished cough reflex -Increased airway hyperreactivity & bronchospasm -Preop PFT, ABG, CXR
65
Heart transplant pt for non-transplant surgery
-Denervated heart = no response to indirect agents (ephedrine, dopamine) -Beta receptor effects exaggerated (EPI & NE) in heart transplants -Isuprel = chronotropic therapy -EKG = 2 P-waves -GETA d/t unable to compensate for hemodynamic changes w/ regional

Liver Kidney + Transplant Anesthesia (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions