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Anaesthesiology
The Renal System and Anesthesia for Urologic Surgery
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
10 sections · 199 slides
Overview
- What this topic covers
- Why the kidney matters to the anesthesiologist
Kidney anatomy and physiology
- Position and surroundings of the kidneys
- Renal pelvis, calyces and nerve supply
- Nerve supply of the bladder, prostate and genitalia
- Gross anatomy and internal structure of the kidney
- The nephron: the working unit of the kidney
- The glomerular filtration barrier
- The vasa recta and the medullary blood supply
- Blood flow and the many functions of the kidney
- Glomerular filtration and arteriolar tone
- Arteriolar tone and glomerular filtration
- Autoregulation of renal blood flow
- Autoregulation of renal blood flow and glomerular filtration rate
- Feedback control of filtration, and urine output
- Sodium reabsorption along the nephron
- Water reabsorption and antidiuretic hormone
- Renin-angiotensin-aldosterone system
- The renin-angiotensin-aldosterone system
- Vasodilator systems opposing the stress response
Clinical assessment of the kidney
- Glomerular filtration rate as a clinical measure
- Creatinine as the practical filtration marker
- Estimating filtration in the perioperative period
- The three main estimating equations
- RIFLE and AKIN criteria
- The KDIGO definition of acute kidney injury
- Relationship between glomerular filtration rate and serum creatinine
- Why a normal creatinine can hide kidney disease
- What the appearance of urine shows
- Fractional excretion of sodium
Perioperative nephrology
- Kidney function as a continuum
- Acute kidney success versus acute kidney injury
- The stress response and the kidney
- Hyponatremia
- Working out the cause and treating hyponatremia
- Hypernatremia
- Why potassium balance is so tightly held
- Hypokalemia
- Hyperkalemia and its ECG changes
- Factors contributing to hyperkalemia in chronic renal failure
- Clinical features of hypocalcemia
- Hypercalcemia
- Magnesium and hypomagnesemia
- Hypermagnesemia
- Phosphate disorders
- Metabolic acid-base disorders
- Respiratory acidosis
- Respiratory alkalosis
- Approaching a mixed acid-base disorder
- Acid-base map for identifying simple and mixed disorders
Acute kidney injury
- Acute kidney injury defined
- The three routes to acute kidney injury
- Prerenal azotemia and how injury becomes established
- Intrinsic and postrenal acute kidney injury
- Nephrotoxins commonly found in the hospital setting
- Nephrotoxins in hospital patients
- Antimicrobial and chemotherapy agents
- ACE inhibitors and angiotensin receptor blockers
- Radiocontrast media
- Non-steroidal anti-inflammatory drugs and diuretics
- Myoglobin and hemoglobin as nephrotoxins
- Nephrotoxicity of volatile anesthetics
- Fluid choice and the kidney
- Chloride load and fluid volume
Chronic kidney disease
- The uremic syndrome
- Manifestations of the uremic syndrome
- Hyperkalemia and acidosis in kidney failure
- Cardiovascular complications of uremia
- Protein binding and volume of distribution
- Volatile anesthetics in renal failure
- Thiopental, ketamine and etomidate
- Propofol and benzodiazepines
- Choosing an opioid in kidney disease
- Nondepolarizing muscle relaxants in renal failure
- Muscle relaxants and succinylcholine
- Atracurium and cis-atracurium
- Laudanosine, vecuronium and rocuronium
- Reversal agents in kidney disease
Diuretic drugs
- Fluid overload and how diuretics work
- Sites of action of commonly available diuretics
- Carbonic anhydrase inhibitors
- Osmotic diuretics
- Does mannitol prevent kidney injury?
- Loop diuretics
- Clinical use and adverse effects of loop diuretics
- Thiazides and distal convoluted tubule diuretics
- Potassium-sparing diuretics
- Dopaminergic agonists and renal-dose dopamine
- SGLT2 inhibitors
- Perioperative handling of SGLT2 inhibitors
High renal-risk surgical procedures
- Acute kidney injury after cardiac surgery
- Clinical risk factors predicting perioperative acute kidney injury
- Off-pump bypass and failed protection strategies
- Kidney injury in trauma and emergency surgery
- Preventing kidney injury in emergency surgery
- Aortic surgery and the kidney
- Endovascular aortic repair
- The KDIGO bundle and future biomarkers
- Jaundice, liver failure and the kidney
Anesthesia for urologic surgery
- Patients presenting for urologic surgery
- Common positioning options for urologic surgery
- Indications and volume of nephrectomy surgery
- Surgical approaches to nephrectomy
- Preoperative assessment for nephrectomy
- Hereditary syndromes and paraneoplastic effects
- Preoperative investigations for nephrectomy
- Monitoring and vascular access for nephrectomy
- Regional technique, induction and analgesia
- Intraoperative complications of nephrectomy
- Postoperative complications of nephrectomy
- Simple and donor nephrectomy
- Radical nephrectomy for renal cell carcinoma
- Extent and outcome of radical nephrectomy
- Radical nephrectomy with inferior vena cava tumor thrombus
- Tumour thrombus in the inferior vena cava
- Surgical strategy by thrombus level
- Anesthetic management of caval thrombus surgery
- Partial, laparoscopic and robotic nephrectomy
- Physiology of carbon dioxide pneumoperitoneum in the Trendelenburg position
- Cardiovascular effects of pneumoperitoneum
- Insufflation pressure and the kidney
- Respiratory and other effects of pneumoperitoneum
- Cystectomy: indications and approaches
- Preoperative assessment for cystectomy
- Intraoperative management for cystectomy
- Enhanced recovery protocols for cystectomy
- Outcomes after cystectomy
- Later problems after urinary diversion
- Crude incidence rates for prostate cancer by race and ethnicity
- Prostate cancer: epidemiology and management choices
- Surgical approaches to prostatectomy
- Anesthetic technique for open prostatectomy
- Bleeding and air embolism in prostatectomy
- Outcomes and extent of radical prostatectomy
- Access difficulties during robotic radical prostatectomy
- Robotic radical prostatectomy
- Positioning safety in steep Trendelenburg
- Respiratory effects of robotic prostatectomy
- Transurethral endoscopic procedures
- Transurethral resection of the prostate
- Preoperative assessment for transurethral procedures
- Anesthetic technique for transurethral procedures
- Hypothermia, bleeding and perforation during TURP
- Complications and mortality after TURP
- Bladder tumour resection and the obturator reflex
- Resectoscopes and laser prostate resection
- Properties of commonly used irrigating solutions for transurethral resection
- Why the irrigating solution matters
- The TUR syndrome
- The three components of the TUR syndrome
- Solution-specific toxicity
- How much irrigant is absorbed
- Minimising absorption and recognising slow-onset cases
- Signs and symptoms of acute hyponatremia
- Clinical presentation of the TUR syndrome
- How the TUR syndrome evolves
- Treatment of the transurethral resection syndrome
- Treating the TUR syndrome
- Central pontine myelinolysis
- Kidney stone types: composition, frequency and causes
- Kidney stone types: composition, frequency and causes (continued)
- Urolithiasis: how common and how stones form
- Diagnosing and treating stones without surgery
- Intervention choices for urinary tract stones
- Medical expulsive therapy
- Preoperative assessment for stone surgery
- Analgesia and monitoring for stone surgery
- Postoperative care after stone surgery
- Sepsis after stone treatment
- Shock wave lithotripsy
- Anesthesia and limits of shock wave lithotripsy
- Contraindications to shock wave lithotripsy
- Percutaneous nephrolithotomy
- Bleeding and anesthesia for nephrolithotomy
- Ureteroscopy and open stone surgery
Other urologic procedures and emergencies
- Urogynecology and stones in pregnancy
- Nitric oxide mediated vascular smooth muscle relaxation and PDE 5 inhibition
- Phosphodiesterase type 5 inhibitors
- Nitric oxide donors and penile prostheses
- Pediatric urologic surgery
- Pheochromocytoma and reconstructive procedures in children
- Other congenital urologic conditions
- Testicular torsion
- Urgency and anesthesia for testicular torsion
- Fournier gangrene
- Managing Fournier gangrene
- Emergency treatment of nephrolithiasis
- Sepsis risk and monitoring in emergency stone surgery
- Key points to carry away
- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition