Renal II

Question 1

Kidney: SNS, PNS, spine levels of pain conduc

Answer 1

T8-L1, X, T10-L1

Question 2

Ureter: NS, PNS, spine levels of pain conduc

Answer 2

T10-L2, S2-4, T10-L2

Question 3

Bladder NS, PNS, spine levels of pain conduc

Answer 3

T11-L2, S2-4, T11-L2 dome/S2-4 neck

Question 4

Prostate NS, PNS, spine levels of pain conduc

Answer 4

T11-L2, S2-4, T11-2, S2-4

Question 5

Penis NS, PNS, spine levels of pain conduc

Answer 5

L1-2, s2-4, s2-4

Question 6

Scrotum NS, PNS, spine levels of pain conduc

Answer 6

Not sig, not sig, s2-4

Question 7

Testes NS, PNS, spine levels of pain conduc

Answer 7

T10-l2, not sig, t10-l1

Question 8

NMB completely reliant on urinary elim

Answer 8

Gallamine, metocurine

Question 9

6 commonly used drugs totally dependent on renal elim

Answer 9

Digoxin, inotropes, aminoglycosides, vanc, cephalosporins, pcn

Question 10

IV agents commonly used in anesthesia partially dependent on renal elim 5

Answer 10

Panc, barbs, atropine, glyco, neostigmine

Question 11

Other drugs partially dep on renal elim 6

Answer 11

Edrophonium, milrinone, hydralazine, cycloserine, sulfonamides, chlorpropamide

Question 12

Approved NMB in renal fail 6

Answer 12

Sux, atra, cis atra, miva, vec, roc

Question 13

NMB to avoid in renal fail 4

Answer 13

D tubo, metocurine, panc, gallamine

Question 14

Opioids approved in renal fail, ones to avoid repeat dosing (*), avoid

Answer 14

Approved: fent, morphine, remi, dilaudid. Avoid demerol

Question 15

IV anesthetics: 4 approved, 2 to avoid

Answer 15

Prop, keta, etomidate, midaz ok. Avoid tpl and diazepam

Question 16

4 drugs concerned about in renal fail

Answer 16

Thiazides, SNP, dig, abx

Question 17

CM of crf: CO, oxy hgb curve shift, bp, sns activity

Answer 17

Increased, right shift, htn, attenuated

Question 18

What should be reduced in mac cases

Answer 18

LA doses

Question 19

Comorbidity to be aware of if doing regional

Answer 19

Autonomic hyperreflexia

Question 20

Cysto: level needed for spinal/epidural, spinal doses, epidural doses

Answer 20

T8-10. Spinal: 0.75% 10-12 mg >1 hr, 7.5 if less <1 hr. Epidural: 1.5-2% lido w epi 15-25 ml, 5-10 ml bolus

Question 21

Cysto maintenance if GA: what not needed, minimal what

Answer 21

NMB. Narcotic

Question 22

Signs of bladder perf in cysto

Answer 22

Unexplained htn, tachycardia, hypotension. Shoulder pain in PACU

Question 23

Osmolality: glycine 1.2%, 1.5%

Answer 23

175, 220

Question 24

Osmolality sorbitol 3.5%, mannitol 5%, cytal

Answer 24

165, 275, 178

Question 25

Osmolality glucose 2.5%, urea 1%

Answer 25

139, 167

Question 26

Irritant should be less than what height, fluid absorbed per surgical time

Answer 26

<60cm above surgical table, 20 ml/min of resection time

Question 27

Turp: abx, ebl, ebl per resection time

Answer 27

80 mg gentamicin slowly, 500 ml, 2-4 ml/min of resection time

Question 28

Technique of choice for anesthesia w m turp

Answer 28

Spinal

Question 29

M turp mortality increase assoc with 4

Answer 29

Procedure >90 min, gland size >45gm, acute urinary retention, >80 yrs old

Question 30

Turp: spinal level needed.why it may be better than ga

Answer 30

T10. Acute hyponatremia from turp syndrome could delay ga emergence

Question 31

Why m turp more at risk for irrigation absorp

Answer 31

B turp and l turp can use ns

Question 32

Turp syndrome: s/s

Answer 32

HA, restless, cyanosis, dyspnea, htn, inc/dec hr, CHF, coma, transient blindness, pulm edema, mi

Question 33

Hyponatremia in turp: <120 se, <115, <102

Answer 33

120: confused, restless. <115: tired, nauseous, dec contractility, hypotension, wide qrs/st elev. <102: sz, coma, dysrhythmias, severe hypotension, pulm edema

Question 34

Turp syndrome tx

Answer 34

Fluid restriction, loop diuretics, hypertonic saline if severe, cv support

Question 35

Eswl: when shock delivered, pacer/aicd at risk for

Answer 35

Ventricular refractory period, arrhythmias

Question 36

Eswl: abs contra 2, relative contra 4

Answer 36

Abs: pregnant, untreated bleeding disorder. Relative: aicd (turn off for procedure), pacer (turn to non demand mode), aortic or renal artery aneurysm (if big), morbid obesity

Question 37

Eswl preop: pts may have what which could alter anesthetic plan

Answer 37

Opioid tolerance if stone attack, NV (RSI), on diuretics (check k)

Question 38

Eswl: anesthesia GA with ___ vent, MAC if regional where/what condition

Answer 38

Controlled. Flank infiltration and IC block if 3rd gen or newer lithotripter

Question 39

ESWL: control ___ ___. Give what. Vent modes

Answer 39

Diaphragmatic excursion. NMB. HFJV

Question 40

ESWL regional: __ __ most common, level required, cons to this method

Answer 40

Continuous epidural, T6. Can’t control diaphragm, hypotension higher risk

Question 41

Laser lithotripsy: which anesthesia method advised. If regional need what level. ___ patient well.

Answer 41

General w/NMB. T8-10. Hydrate

Question 42

Perc nephrostomy: pt positioning. Risks to pt

Answer 42

Lithotomy then prone. Trauma to spleen/liver/kidney, ptx, bleeding

Question 43

Radical prostatectomy: co ex diseases, risk of what, need what kind of access

Answer 43

CAD, COPD, renal dysfunc. Sig blood loss. Wide IV and invasive monitoring

Question 44

Radical prostatectomy: consider what for blood control, __ __ position, risk of what

Answer 44

ANH or autologous blood donation, hyper extended, VAE

Question 45

Radical prostatectomy: surgeon may ask to give what, SE

Answer 45

Indigo carmine, alters p ox readings

Question 46

First sign vessel has been knicked in prostatectomy

Answer 46

End tital drop

Question 47

Access for radical prostatectomy

Answer 47

Aline, 1-2 large IVs

Question 48

Fluid for radical prostatectomy

Answer 48

NS or LR 5 ml/kg/hr

Question 49

Reg for radical prostatectomy: need what level, what used for spinal v epidural

Answer 49

T8. Spinal: 0.75% bupiv or hyperbaric tetracaine. Epidural 1.5-2% epi 20 ml

Question 50

5 complications of radical prostatectomy

Answer 50

Hemorrhage, hypothermia, vae, common peroneal injury d/t lithotomy position, dvt w pe

Question 51

Pain mgmt for radical prostatectomy

Answer 51

Morphine 2-4 mg q 10-15 min or pca

Question 52

Radical nephrectomy: access, co ex diseases 5

Answer 52

Large iv, a line, central line left side if ivc involved or if not same side as nephrectomy. Paraneoplastic syndrome, smoking, cad, COPD, renal failure

Question 53

Radical nephrectomy: levels that may be inc/altered

Answer 53

Hypercalcemia, eosinophilia, inc prolactin, EPO, glucocorticoids

Question 54

Nephrectomy for RCC: co ex diseases 3, most pts are what, may need what preop

Answer 54

Htn, dm, smoking. Anemic. TRANSFUSION

Question 55

RCC nephrectomy: expect what intraop 2

Answer 55

Extensive blood loss. Retraction of IVC leads to hypotension

Question 56

Prostate cx pelvic lymph dissec: positioning, potential for what, avoid using what/why

Answer 56

Steep trend, hypothermia from irritant, nitrous- prevent bowel distension

Question 57

Bilateral orchid to my: procedure duration

Answer 57

20 min, dont use long acting agents

Question 58

Bladder cx: what is linked to it, may receive what preop

Answer 58

Smoking. Radiation

Question 59

Radical cystectomy: expect large what, which anes method preferred, access

Answer 59

Blood loss. Ga w NMB. A line, cvp if cardiac pt

Question 60

Radical orchid to my: pts typically ___ and have what. Which chemo used/se. Can use what kind of anesthesia

Answer 60

Young. Bone marrow supp. Bleomycin, pulm fibrosis. RA or ga