Flashcards in Renal Disease - Co-Existing Deck (15):
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 ******
Positive Pressure Ventilation
*increased PIP and PEEP = decreases 3?
*what will overcome these changes by improving CV function?
* GFR, RBF, UOP
Renal Failure - Impact on drugs (5?)
*decreased serum protein
*abnormal cell membrane activity
Drugs completely eliminated by the kidneys (2?)
Which are unaffected?
Which are highly PB?
Unaffected - propofol, ketamine, etomidate
PB - TPL, precedex, midazolam (active metabolite)
Induction Meds: Opioids
*Opioids with active metabolite?
* High PB?
* good choices in RF?
*morphine, meperidine, hydromorphone
*fentanyl, alfentanil, remifentanil
*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)
Reversals and anticholinergics in RF?
*e 1/2t of reversal significantly prolonged in RF
* anticholinergics - accumulation 50% of drug excreted unchanged
Induction considerations of the RF pt?
- drugs/ drugs to avoid? - positioning
- intubation tech -nerve injury
- 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
* 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
Regional Anesthesia - RF
*for shunt placement?
* consider RA in (2?):
*brachial plexus block + opioids + LA
*uremic enchephal and coag issues
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
Cystoscopy: short procedure (15-20min)
- 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
Spinal and Epidural?
* _______ = sympathmectomy will decrease catechols, renin and vasopressin
*renal perfusion pressure maintained via??
* AVOID ?
*RBF and GFR (fluid boluses)