Quiz 4 Flashcards
(27 cards)
Upper urinary tract includes
ureter and kidney
lower urinary tract includes
Bladder, prostate and urethra
Nerve injuries- usually performed in lithotomy position (5)
- Common peroneal
- Obturator
- Femoral
- Saphenous
- Sciatic
common peroneal pressure
Compression of fibular head on leg brace
Saphenous nerve pressure
Compression of medial tibial condyle
Sciatic nerve pressure (2)
- Excessive external rotation of legs
- Excessive extension of the knees
Obturator and femoral nerve
Excessive flexion of the groin
Obturator reflex and increased risk?
Bladder rupture/injury secondary to adductor muscle contraction from obturator nerve stimulation from electrocautery.
This risk is increased when resecting lateral wall tumors, as electrosurgical resection of these lesions is more likely to inadvertently stimulate the obturator nerve.
regional anesthesia location for cystoscopy (2)
- T9-T10 sensory level is required
- T8 for ureters
general and regional considerations for TURBT
General anesthesia - no coughing or straining can cause bladder perforation
Regional anesthesia - the bladder becomes atonic and may become thinner when distended, increasing the risk of perforation (better for elderly)
Bladder perforation (5)
- Awake patient will experience suprapubic fullness, abdominal spasm and pain
- Htn and tachycardia are early signs followed by severe hypotension
- Cool irrigation causes vasoconstriction-systemic cooling—warm fluids will decrease this risk
- DIC triggered by release of prostatic thrombogenic substances-especially with cancer of prostate
- Possibility of open procedure
characteristics of solution to distend bladder
- optically clear
- nonconductive
- nonhemolytic
- nontoxic
TURP-Spinal considerations (3)
- The bladder will be atonic with a large capacity, thus glycine infusion pressure can be low, emptying less frequent, facilitating resection
- Postoperative bladder spasm is prevented allowing for hemostasis
- Awake patients may supply early detection of complications
venous absorption of fluid in TURP? Early signs? Causes what?
Early signs- hypertension and tachycardia
- CVP may rise as cardiac decompensation occurs
- Awake patient may complain of dyspnea or nausea
- Hypoxia and /or hyponatremia
TURP SYNDROME
other names for TURP syndrome
WATER INTOXICATION
GLYCINE TOXICITY
TURP syndrome causes (4)
- Apprehension
- disorientation
- convulsions
- coma
Irrigation solutions and their risks (3)
Glycine (1.5%) – blindness/visual impairment
Sorbitol (3.3%) – high blood sugars/lactic acidosis
Mannitol (5%) - hypervolemia
Look at slide 30
.
more blood loss in which open prostatectomy procedure and due to what?
Retropubic approach
control of dorsal venous complex
radical prostate: dyes used and side effects (2) What happens to O2 sat?
Methylene blue 1% - CAN CAUSE HYPOTENSION
Indigo carmine dye - 0.8% has an alpha sympathomimetic effect increase BP
85% can go as low as 65% (more so methylene blue)
risk during nephrectomy
Lateral-flex table and use kidney bar - May cause vena cava compression and hypotension
renal transplant avoid which drugs?
- succinylcholine
- atracurium
- LR
- K+
solution in kidney preservation contains
- glucose
- potassium
- magnesium
- antibiotics
- sodium bicarb
- heparin
(can trigger hypersensitivy reaction in recipient)
renal perfusion vs cold storage time frames
perfusion - 72 hours
cold storage - 48 hours
