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37 Cards in this Set
- Front
- Back
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What combinations of medications have improved kidney survival?
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cyclosporin A, azathioprine, steroids
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When should a patient getting a kidney transplant be dialyzed prior to surgery?
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within 24 hours
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What is the mechanism of cyclosporine?
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inhibits T-lymphocyte mediated immune response without affecting B lymphocytes(metabolite produced by fungus)
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Besides transplantation cyclosporine is used in what other conditions?
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crohn's, uveitis, psoriasis, RA
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What is the most important and frequent side effect of cyclosporine use and what should you do to monitor for it?
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nephrotoxicity, renal function testing and cyclosporine blood levels
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Besides nephrotoxicity what other side effects are caused by cyclosporine?
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htn, paresthesias, seizures, gum hyperplasia, hirsuitism, hyperglycemia
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What are preop considerations in renal transplant patients?
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volume status, Hgb levels, potassium and other electrolytes
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What are functions of the liver?
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glucose homeostasis, fat metabolism, protein synthesis, cholinesterase, conjugation, coagulation factor production, bilirubin production, bile excretion, acid disposition/disposal
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What are indications for liver transplantation?
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end stage cirrhosis, metabolic diseases(wilson's disease, hemochromatosis), fulminant hepatic failure
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should you use an esophageal stethoscope or NG tube in a patient with esophageal varices?
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they are relatively safe
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What lines should likely be present during liver transplantation?
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two 14g IVs and an 8.5F antecubital catheter
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How should you induce a patient undergoing liver transplantation?
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RSI because of ascites and elevated intraperitoneal pressure
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If you use N2O during a liver transplantation when should you consider discontinuing it?
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at the time of reperfusion when the risk of venous air embolism is heightened
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What are the 4 stages of liver transplantation?
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mobilization of the recipeint's liver, anhepatic phase, post-revascularization, and biliary reconstruction
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what are anesthetic concerns during the hepatectomy(mobilization of recipient liver) phase of liver transplantation?
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bleeding, compression of IVC and pericardium and porto-femoral-axillary bypass
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How often should you check coagulation, acid-base, and electrolyte levels during the hepatectomy phase and why?
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every one half to one hour, glucose levels increase, administration of FFP and cryo(keep agove 100mg/dl), can also monitor thromboelastogram
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When does porto-femoral-axillary bypass begin during liver transplantation and what does this cause pertaining to CVP and PAP?
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at the conclusion of the hepatectomy phase, CVP and PAP increase due to increased flow through the SVC system(adult flow is 1-4L/min)
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What monitoring should you pay special attention to during the hepatectomy phase?
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check and correct coagulation, acid-base, and electrolyte abnormalities, monitor and maintain fluid balance, initiate diuresis
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What events mark the beginning and the end of the anhepatic phase?
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removal of the liver to hepatic arterial anastomosis
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What vessels are clamped during the anhepatic phase?
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portal vein, hepatic artery and inferior vena cava above and below the liver
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What are the benefits of using venovenous bypass during the anhepatic phase?
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decrease blood loss from the surgical field, lessen hemodynamic instability
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What are complications of veno-venous bypass?
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increased risk of air embolism and vascular injury
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Why would you consider giving dopamine during the anhepatic phase?
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induce diuresis during this period of decreased renal perfusion
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What metabolic abnormalities are frequently present during the anhepatic phase?
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metabolic acidosis, hyperkalemia, citrate toxicity
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What events constitute the post-revascularization phase of liver transplantation?
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unclamping of the liver to biliary reconstruction
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What are major problems during the post-revascularization phase of liver transplantation?
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metabolic and hemodynamic perturbations, hyperkalemia, metabolic acidosis, hypothermia, air embolism, and RV overload, fibrinolysis
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What age is optimal for donor hearts?
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from 35-40yo
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What are problems that relate to the donor during liver transplantation?
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temperature control, fluid and electrolyte balance, with frequent diabetes insipidus, cardiovascular stability, pulmonary function(frequent development of pulmonary edema)
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What monitors should you use for heart transplantation?
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arterial line, L sided IJ(R IJ is commonly utilized for subsequent punture and transvenous endomyocardial biopsy)
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What about pulmonary status in a patient getting a heart transplant is of important consideration?
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pulmonary htn, nitric oxide can be beneficial
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What is the eventual baseline heart rate following cardiac transplantation?
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90-110bpm
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What cardiac rhythm is frequently encountered in the first few days after cardiac transplant?
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bradycardia(secondary to sinus node dysfunction)
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What medication are patients on for 2-3 days after heart transplantation?
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isoproterenol(transplanted heart is denervated)
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How does the transplanted heart respond to laryngoscopy?
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sympathetic responses are usually absent
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How are baroreceptor reflexes and responses to valsalva affected after heart transplantation?
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absent
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How are changes in CO made after heart transplantation?
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changes in stroke volume because heart rate is relatively constant
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How does the transplanted heart react to sympathomimetics such as isoproteronol, epinephrine, dopamine, and dobutamine?
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receptors function normally so they have their normal effect
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