Renal Disease - Co-Existing Flashcards
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
* hydration
Renal Failure - Impact on drugs (5?)
- anemia
- decreased serum protein
- elyte abnormalities
- fluid retention
- abnormal cell membrane activity
Drugs completely eliminated by the kidneys (2?)
- gallamine
* phenobarbtial
Induction Meds:
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
- morphine
- 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
- 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
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
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)
- 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
Spinal and Epidural?
- _______ = sympathmectomy will decrease catechols, renin and vasopressin
- renal perfusion pressure maintained via??
- AVOID ?
- T4-T10
- RBF and GFR (fluid boluses)
- hypotension
Extracorpeal Shock Wave Lithotripsy (ESWL):
- goal of GA?
- RA level?
- control diaphragmatic excursion
* T6
