Adv Principles Week 1 - Gu Surgery

Front 1

With GU surgery what sensory level is preferred for regional anesthesia?
A. T4
B. T5
C.T6
D.T7
E. T10

Back 1

T10= umbilicus

Front 2

With GU procedures, regional anesthesia is preferred because mental status is easily evaluated, signs and symptoms of bladder perf are evident, and there is a reduced incidence of DVT.

Back 2

Statement

Front 3

True or False: Sedation for GU procedures may mask signs of water intoxication.

Back 3

True

Front 4

The following symptoms are common for what type of bladder perforation?

-periumbilical , inguinal, or suprapubic pain, lower abdominal distention, & pain.

Back 4

Extraperitoneal bladder perforation

Front 5

The following symptoms are characterized by what type of bladder perforation?
- abdominal rigidity, distention, pain, referred shoulder pain, hiccup, shortness of breath, tachycardia, hypo or hypertenstion, diaphoresis, and vomiting.

Back 5

Intraperitoneal bladder perforation pg. 720 Nag.

Front 6

Which of the following is not a complication associated with GU TURP surgery?
a.TURP syndrome
b.hyperthermia
c. hypothermia
d. bladder perforation
e. coagulopathy (rare)
f. septicemia

Back 6

b. hyperthermia
They use cold rather than warm fluid to prevent vasodiation and further bleeding with the procedure

Front 7

Blood loss with a TURP procedure: choose all that apply

a. is difficult to assess
b. depends on the size of the gland (>45 gm)
c. depends on the resection time (>90 mins)
d. depends on the surgeons skill
e. averages 6-8 ml/min resection time = 400-600ml
f. transfusion is indicated in 2.5% patients

Back 7

a, b, c, d, f are true
the average blood loss is 3-5ml/min of resection time totaling 200-500ml.

Front 8

- According to our lecture, the reccomended resection time for a TURP procedure should be less than 60 mins. Blood loss depends on a resection time > 90 mins based on the notes.

Back 8

.

Front 9

True or False: TURP syndrome doesnt occur after 24 hours post procedure and therefore is unimportant at that time.

Back 9

False: TURP syndrome can occur up to 24 hours post procedure and occurs in 2-10 % of TURP patients.

Front 10

Cardiovascular symptoms of TURP syndrome include: choose all that apply
a. CHF
b. pulmonary edema
c. hemolysis
d. hypertension
e. bradycardia
f. hypotension
g. fever

Back 10

Fever is not mentioned and is not a CVS symptom of TURP

Front 11

Neurologic symptoms of TURP include all of the following except:
a. seizures
b. coma
c. death
d. confusion
e. restlessness/agitation
f. somnolence

Back 11

f. patients are more likely to be restless and agitated than somnolent unless sodium levels fall to drastic levels.

Front 12

Movement of intravascular water into cerebral cells causes......

Back 12

cerebral edema

Front 13

The leg height in the lithotomy position is an important anesthetic consideration because?

Back 13

the higher the legs, the increase in risk for decreased perfusion d/t gradient from heart to legs

Front 14

exaggerated lithotomy position is most commonly used for which kind of surgery?
A. TAH
B. TURP
C. radical prostatectomy
D. hemorrhoidectomy

Back 14

C

Front 15

Resp. considerations of lithotomy position include:

A. risk of tube migration down R mainstem when legs elevated

B. diaphragm shifting cephalad

C. increased abdominal pressure on diaphragm

D. decreased FRC

Back 15

All are correct

Front 16

Why are regional anesthetic techniques preferred for GU surgeries?

Back 16

sedation can mask mental status changes associated with TURP syndrome

Front 17

TURP syndrome is also known as
(2 things)

Back 17

water intoxication
dilutional hyponatremia

Front 18

Common peroneal nerve injuries can lead to what complication?

Back 18

footdrop

Front 19

Compartment syndrome is a complication of lithotomy position: T or F

Back 19

T

Front 20

What causes TURP syndrome?

Back 20

Absorption of irrigating fluid through venous sinus near the prostate.

Front 21

What causes the symptoms of TURP Syndrome?
a. dilutional hypernatremia
b. dilutional hyponatremia
c. hyperkalemia
d. hyperosmolality

Back 21

B

Front 22

Which is NOT a contributing factor to TURP syndrome?
a. irrigation fld pressure
b. hypotonicity of irrig fluid
c. solute toxicity
d. prostate resection time of 45-60min
e. >20ml of irrig fluid absorbed per min
f. resection time of 15-18min

Back 22

All contribute except F. Shorter times are better.

Front 23

The ideal irrigating fluid for TURP procedures will have all except:
a. isotonic
b. contain K+
c. inexpensive
d. non-hemolytic
e. tranparent

Back 23

B is false. We want a non-electrolyte fluid to not interfere with the electrical current of the cautery.

Front 24

T/F: Mannitol is the best irrig fluid to use for a CHF pt having a TURP b/c of it's diuretic effects.

Back 24

FALSE: Before diuresis occurs, mannitol first increases circulating blood volume which can overload a CHF pt.

Front 25

Which two types of patients should Glycine not be used as the irrigation fluid during a TURP?
a. severe hepatic dz
b. L-arginine deficiency
c. Diabetic
d. CHF patient

Back 25

A b/c glycine is metabolized in the liver to ammonia.
B...not sure why. Not mentioned in textbook, but is on slide. I think it's related to metabolism of the glycine.

Front 26

T/F: Glycine toxicity may lead to tinitis.

Back 26

False: Blindness that resolves with decreasing NH3 levels.

Front 27

Back 27

CNS innervation of the Bladder

Front 28

What are two common methods of Regional Anesthesia used for Bladder procedures:

a. Spinal
b. Brachial plexus block
c. Epidural
d. SAB (subaracnoid)

Back 28

c & d

Front 29

What dermatone level needs to be blocked when using a Regional technique for bladder procedures?

Back 29

T-10 level

Front 30

When using regional anesthesia for bladder procedures, which method will have a "shorter onset":

a. SAB
b. epidural

Back 30

SAB

Front 31

Common dose for SAB when doing bladder procedures?

What is the duration of action?

Back 31

45 mg 1.5% lidocaine

45-60 minutes

(can add epi 1:200K)

Front 32

The prostate gland increases in size after what age?

Back 32

after age 40

Front 33

What GU condition leads to bladder neck obstruction?

Back 33

BPH

Front 34

Benign prostatic hypertrophy frequently leads to....

choose 3

a. recurrent GU infections
b. bladder stones
c. erectile dysfunction
d. renal insufficiency

Back 34

a, b, d

Front 35

Indications of Transurethral surgery of the prostate (TURP) include:

(gland volumes)

a. >50 ml
b. 20-30 ml
c. 40-50 ml
d. <30 ml

Back 35

c

Front 36

What are 3 resection methods used for the TURP procedure:

a. electrosurgical loop
b. Laser
c. fiberoptic
d. microwave

Back 36

a,b,d

Front 37

T or F

to avoid bleeding during the TURP procedure it is important to stay within the prostatic capsule.

Back 37

True

Front 38

Violation of the prostatic capsule during the TURP procedure results in absorption of fluid into _____________?

Back 38

venous sinuses

Front 39

Na lower than 120meq/ml will produce all the following signs and symptoms except:
1. CNS symptoms
2. HA
3. Irritability
4.Confusion
5. Absence of P waves
6. Possible widening QRS

Back 39

5. Absence of P waves.

Front 40

ECG changes, wide QRS, ST elevation, nausea, somnolence can be found in what level of Na?

Back 40

Na level lower than 115meq/ml

Front 41

Na level of 100meq/ml can lead to:

Back 41

VT or VF, seizure, coma

Front 42

True or False:
Symptoms of low Na is related to acuteness of changes

Back 42

True

Front 43

True or False:
In GU patients, Na+ and osmolality should be reported separately

Back 43

False-They should be reported together.

Front 44

It is important to monitor the patient's ECG and blood pressure during ESWL?

Back 44

Yes, The ECG must be of good quality because the R wave is used to trigger the shock. (Naglehout, p 718)

Front 45

What are the most common dysrhythmias seen with ESWL?

Back 45

PVC's and supra ventricular premature complexes. (Naglehout, p718)

Front 46

List respiratory issues with ESWL

Back 46

Increased work of breathing
Decreased FRC and VC

Front 47

List CV issues with ESWL

Back 47

Hypotension d/t vasodilation
Cardiac arrythmias
Hypotension after removal from bath

Front 48

What are advantages of current lithotripters?

1. Pads are gel-filled
2. Only need one treatment
3. Decreased need for anesthesia
4. Machines aren't as powerful

Back 48

1, 3 and 4 true
2. false - may need repeated treatments

Front 49

True or False:
BBB is permeable to solutes >8angstoms

Back 49

False-It is impermeable to solutes >8 angstoms.

Front 50

True or False:
GU patients have problem with hyperosmolality in brain cells

Back 50

False: False-their problem is hypoosmolality in brain cells.

Front 51

Treatment of low Na+ include all except:

1. Early recognition and diagnosis
2. Fluid restriction
3. Diuretic
4. Supportive treatment
5. 5-10% saline at 100ml/h or less

Back 51

5. 5-10% saline at 100ml/h or less(correct concentration is 3-5% saline)

Front 52

ESWL stands for:

Back 52

Energy Sound Waves Lithotripsy

Front 53

Match the following with the indication:
1. Laser lithotripsy___________
2. ESWL______________

a. For stones in the kidney or upper 2/3 of ureters
b. For stones in the lower ureter

Back 53

1b.
2a.

Front 54

Current lithotripters:
>___-_____ pad rather than _____
>Most not as _________
>May need ______ treatments
>________ need for anesthesia

Back 54

Current lithotripters:
>Gel-filled pad rather than water
>Most not as powerful
>May need repeat treatments
>Minimizes need for anesthesia

Front 55

Current lithotripters procedure:

>__________ to locate stone
>___ shocks/min
>_____-______ shocks per treatment
>Lasts __-__ minutes
>___ sufficient

Back 55

Current lithotripters procedure:
>Fluroscopy to locate stone
>120 shocks/min
>2500-4000 shocks per treatment
>Lasts 30-60minutes
>MAC sufficient

Front 56

To avoid cardiac arrythmias ESWL shocks are timed to occur ___ _____ after the __ wave.

Back 56

To avoid cardiac arrythmias ESWL shocks are timed to occur 20 msec after the R wave.

Front 57

General ESWL complications include:

Back 57

Cardiac arrythmias
Flank Pain
Hematuria
Bruising
Soft tissue swelling
Pulmonary Contusions
Pancreatitis

Front 58

Anesthetic Implications of ESWL

Back 58

Pt must be immobile
Water bath requires GA or regional
Sedation adequate for modern lithotripters

Front 59

6 common GU procedures

Back 59

1.cysto
2.TURP, TURBT
3.Retrograde pyelogram
4.Ureteroscopy
5.Ureteral stent inseration
6.Lithotripsy

Front 60

How long does a cystoscopy usually last?

Back 60

5-30 min

Front 61

Purpose of cystoscopy

Back 61

examination of the bladder

Front 62

Cysto is always therapeutic.
T or F

Back 62

False can be just for diagnosis

Front 63

Cysto bladder is distended with fluid.
T or F

Back 63

True

Front 64

Two type of scopes used for cysto

Back 64

rigid or flexible

Front 65

What type of topical is generally used injected into urethra for cysto?

Back 65

2% Lidocaine

Front 66

Amt of Lido for cysto for male?
Female?

Back 66

Male 15-30 ml
Female 3-5 ml

Front 67

General anesthesia for cysto?

Back 67

Any agent. Adjust to pt comorbidites

Front 68

GA for cysto always use LMA
T or F

Back 68

False may use mask