Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

Liver + Transplant Anesthesia Flashcards

(66 cards)

Start Studying
1
Q

What is the functional unit of the liver?

A

Hepatic lobule or acinus

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

What does the hepatic artery branch from & how much oxygenated blood is delivered?

A

-Aorta
-Delivers 400-500 mL/min O2 blood

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

How much blood is delivered to the liver (arterial + venous)

A

Hepatic artery & portal vein = 1.5 lpm

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

Hepatic artery pressure is __________ mmHg which is similar to the aorta

A

6-10 mmHg

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

The hepatic artery has what receptors & what properties?

A

-Alpha adrenergic = vasoconstricting

-Beta receptors = vasodilating

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

The portal vein has what receptors & properties?

A

Alpha adrenergic + Dopaminergic 1

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

How does glucagon affect the hepatic artery?

A

Dilates Hepatic Artery

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

How does angiotensin affect the hepatic artery & subsequently hepatic blood flow?

A

Hepatic artery constricts & decreases HBF

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

How does vasopressin affect intrahepatic portal vessels?

A

Dilates intrahepatic portal vessels

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

What happens when there is a decrease in portal vein flow?

A

Compensatory increase in hepatic artery flow

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

Describe the “internal liver blood blank” or reservoir function

A

Doesn’t last very long & doesn’t work very well under GA.

-Autotransfusion of 300-350mL of blood can be shifted into central venous circulation
-If CHF = can be up to 1L of blood in liver d/t increased CVP

-Low resistance sinusoids allows a lot of blood to flow through the PV w/ 10% of TBV in liver

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

Arterial Buffer Response

A

Regulates tone via local & intrinsic mechanisms that adjust arterial flow to compensate for changes in portal flow.
-AKA own system within a system which is why the liver can regenerate itself

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

What are the clotting factors synthesized by the liver?

A

1972 + 510

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

What undergoes metabolism in the liver

A

Carbs, lipids, proteins, hormones, bili, drugs

-Drugs = phase 1 & phase 2 reactions

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

What anesthetic drugs have a HIGH hepatic extraction ratio that is dependent on hepatic blood flow?

A

marcaine, ketamine, lidocaine, metoprolol

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

What anesthetic drugs have a LOW extraction ratio that is independent of liver blood flow?

A

ROC, thiopental, phenytoin

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

Shunts of the portal system do what to 1st pass metabolism

A

decreases first pass metabolism

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

Phase 1 reactions metabolize…

A

Anesthetic drugs

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

Hypoalbuminemia & drugs

A

Increased free drug w/ increased Vd.

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

Anesthetic agents affect on liver

A

Decrease HBF & hepatocellular function

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

What kind of drugs does albumin bind

A

Acidic drugs

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

MELD score uses what 4 categories for grading/

A

INR, Creatinine, Bilirubin, Sodium

“I create bull-shit”

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

A MELD score <11 means

A

low postop mortality w/ an acceptable surgical risk

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

MELD score >20 means

A

Elective surgery delayed until after transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Causes of liver cirrhosis
viral, autoimmune, toxic, metabolic, biliary, vascular, genetic, iatrogenic
26
Which drug works wonders for acute intoxication/
Dexmedetomidine
27
What labs are critical to look at with liver disease because these will change your anesthetic
Albumin & PT
28
Cirrhosis patients and LES
Incompetent LES with abdominal distention. PPV >20 cmH2O can cause seriously problems -Aspiration prophylaxis. Mayka gives Famotidine, Zofran, Dexamethasone upfront
29
What visual test should be done prior to liver transplant
EGD
30
What do avoid with cirrhosis management
Hypotension, hypocarbia, PPV >20 if possible
31
What invasive monitorning device should be considered in cirrhosis
CP or PA pressures for PAH
32
How does fentanyl effect the elderly liver
Decreased clearance d/t HBF decrease
33
How does fentanyl effect HBF
No change or increase in HBF
34
How does sufenta effect HBF
Decreases hepatic blood flow -Extensive hepatic extraction = sensitive to changes in HBF
35
How does Remi effect HBF
Not altered in hepatic failure because it is metabolized by nonspecific plasma & tissue esterases
36
Meperidine & hepatic metabolism
90% hepatic metabolism Prolonged elimination with cirrhosis/liver failure
37
Ester local anesthetic metabolism & liver disease
Slowed with liver disease or increased BUN
38
Propofol & liver
Decreases P450 activity -Boluses decrease HBF by 40% - Undergoes rapid hepatic metabolism
39
Etomidate & liver
CAUTION with low albumin levels -Good for cardiac patients -Decreases HBF & inhibits P450 activity -Highly protein bound
40
Ketamine & liver
Causes enzyme induction w/ repeated exposure -P450 metabolism
41
Succinylcholine & liver
-Liver disease must be severe before a decrease in plasma cholinesterase production & sufficient to prolong effect -Pseudocholinesterase t1/2 = 8-16hr
42
Vecuronium & liver
-40-75% biliary excretion -Prolonged excretion w/ cirrhosis
43
Rocuronium & liver
Prolonged excretion w/ cirrhosis
44
Important to verify/check when paralyzing a patient with possible liver disease/cirrhosis
Check twitches after SUX & before ROC to verify no pseudocholinesterase deficiency
45
What volatile anesthetic(s) cause a minimal dose-dependent decrease in hepatic artery & portal vein blood flow?
ISO & SEVO
46
What volatile anesthetic(s) causes moderate dose-dependent decrease in hepatic artery & portal vein blood flow
DES
47
Preoperative consideration with liver/liver transplant patients
-GA = RSI d/t ascities & increase IAP -Induction etomidate? -SUX vs ROC -1/2 MAC -Narcs -A-line + CVP + 2 large boare IV -Rapid infusion system
48
Preanhepatic phase
Stage 1 -Incision until access to liver vessels obtained
49
Issues with preanhepatic phase
-Sequestration of blood + volume status -Citrate intoxification causing hypocalcemia -Potassium < 4 d/t diuresis, insulin, glucose -Temperature =ice cold liver on field, warm ischemia time -Bypass flow
50
MAP goal during preanhepatic phase. What drugs to maintain?
NE or vasopressin to keep mean BP >60 mmHg
51
Cardiac output goal during preanhepatic phase. What drugs to maintain?
Dopamine or EPI to keep CO >5 lmp
52
Heme goals during preanhepatic phase
Hgb >7 g/dL PLT >40K MA (TEG) >45 Fibrinogen > 100 mg/dL
53
Mannitol dose prior to anticipating clamping during preanhepatic phase
0.5g/kg over 1 hour prior to anticipating clamping
54
3 things to do just prior to clamping during preanhepatic phase
-IV heparin if TEG is normal or hypercoagulable -Increase CVP to 10cmH2O w/ crystals -25% albumin if severely low albumin
55
Stage II/Anhepatic Phase is when ...
Liver vessels clamped or hepatectomy until reperfusion
56
Stage II/Anhepatic phase issues
-Sequestraion of blood & hypotension d/t vena cava cross clamp (50% decrease in venous return) -***Citrate intoxification = hypocalcemia --> give amps of calcium when hypoperfusing -K below 4 from diuresis, insulin, glucose -Ice cold liver on field, warm ischemia time -Bypass flow
57
V-V bypass during Anhepatic Phase
-Cannula in portal vein -Iliac vein drain to heparin bonded pump -Return by axillary or jugular bypass **Benefit able to replace clamps in stage III if needed
58
Neohepatic phase/Stage III
-Reperfusion of graft to end of case ***Greatest hemodynamic changes seen
59
Issues seen in neohepatic phase
-Acute hyperK -Reperfusion syndrome -PE & or edema -Coagulation -Anastamosis leak/injury of IVC -Assessing quality of donor organ
60
Reperfusion syndrome
-Brady, HoTN, Decreased CO -Release of cytokines, cold acidosis, products of ischemic metabolism -Clotting system activation -Lysis occurs: TXA **Tx --> EPI & defibrillator available -HCO3 & CaCl to conteract hyperkalemia
61
TEG R-time
prolonged d/t heparin, thrombocytopenia, lysis *Tx = FFP
62
TEG MA
Function of PLTs *Tx = PLT
63
TEG angle <20 degrees
Thrombocytopenia, PLT dysfunction, decreased thrombin, decreased clotting factors *Tx = CRYO or PLT
64
Fibrinolysis on TEG
Not often seen. *Tx = Amicar 250-500 mg IV
65
3 Channel on TEG
1- Natural 2- Protamine if heparin effect is removed 3- Amicar how blood would clot if lysis stopped **If amicar channel is "better" than the other 2 = Lysis
66
When treating HTN during liver transplant. What antihypertensives do you want to avoid?
Avoid long acting agents

Liver Kidney + Transplant Anesthesia (2 decks)

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