Renal Disease - Co-Existing Flashcards Preview

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Flashcards in Renal Disease - Co-Existing Deck (15):
1

VAs - Nephrotoxic?

*concern is production of ? -> leading to tubular injury and ARF
*avoid which VAs?
*issue with halothane?
*which VA are ideal in RF?

* free fluroide ions
* methoxy > enflurane >/= sevo (cmpd A)
* AVOID - increase K+/acidosis - myocardial depression
*des and iso are good ******

2

Positive Pressure Ventilation

*increased PIP and PEEP = decreases 3?
*what will overcome these changes by improving CV function?

* GFR, RBF, UOP
*hydration

3

Renal Failure - Impact on drugs (5?)

*anemia
*decreased serum protein
*elyte abnormalities
*fluid retention
*abnormal cell membrane activity

4

Drugs completely eliminated by the kidneys (2?)

*gallamine
*phenobarbtial

5

Induction Meds:

Which are unaffected?
Which are highly PB?

Unaffected - propofol, ketamine, etomidate
PB - TPL, precedex, midazolam (active metabolite)

6

Induction Meds: Opioids

*Opioids with active metabolite?
* High PB?
* good choices in RF?

*morphine, meperidine, hydromorphone
*morphine
*fentanyl, alfentanil, remifentanil

7

*MR to avoid in RF
- (primarily dependent of renal excretion) = 6?
* MR ok to dose normally?
*Caution with ?

* d-tubo, metocurine, gallamine, pancuronium, pipercurium, doxacurium
*atracurium, cistracurium, mivacurium
*succs - increased K+

(vec and roc - single dose OK)

8

Reversals and anticholinergics in RF?

*e 1/2t of reversal significantly prolonged in RF
* anticholinergics - accumulation 50% of drug excreted unchanged

9

Induction considerations of the RF pt?
- drugs/ drugs to avoid? - positioning
- intubation tech -nerve injury
- HTN?

- TPL (titrate - high PB and acidic), etomidate = good, propofol = OK (BP?), avoid ketamine (HTN), avoid succs
- RSI -full stomach? (increased gastric volume and delayed gastric emptying) - H2 blocker (renal excretion- reglan accumulates)
- tx HTN with BB (lido to blunt SNS)
- positioning - prone to fractures (hypoCa)
- nerve - uremic neuropathy

10

Maintenance:

*Technique?
* avoid hypercapnia b/c it leads to?
* alkalosis: OXYHGB curve?
* if pt remain HTN - give 3?
* fluids - avoid?

* short acting opioid with N2O/O2/agent
* increases acidosis and leads to arryhtmias
* shift to the left
* NTG, hydralazine, increase IA
* LR

11

Regional Anesthesia - RF

*for shunt placement?
* consider RA in (2?):

*brachial plexus block + opioids + LA
*uremic enchephal and coag issues

12

Vasopressors: goal to maintain adeq intravascular volume and minimize CV depression
*greatest interference with renal circulation/AVOID?
* increase myocardial irritability (do not decrease RBF?)

*alpha adrenergic agonists - phenyl
* beta adrenergic

13

Cystoscopy: short procedure (15-20min)
- positioning?
- GA?
- RA? which level?
- obturator nerve?

* lithotomy (nerve injury, ^ VR = CHF exacerb, dec FRC)
* GA with LMA
* spinal > epidural (long onset) @ T10
* only blocked with paralysis, will external rotation and adduction of thigh

14

Spinal and Epidural?
* _______ = sympathmectomy will decrease catechols, renin and vasopressin
*renal perfusion pressure maintained via??
* AVOID ?

* T4-T10
*RBF and GFR (fluid boluses)
* hypotension

15

Extracorpeal Shock Wave Lithotripsy (ESWL):

*goal of GA?
*RA level?

*control diaphragmatic excursion
*T6