What is the most common nerve injury in the lithotomy position?
Peroneal nerve injury
What are the normal values for GFR? BUN? Creatinine?
GFR: 125 mL/min
BUN: 8-18 mg/dL
Creatinine: 0.8-1.2 mg/dL
What are some symptoms of moderate renal insufficiency?
elevated BUN and Creatinine
anemia
decreased energy
What are some symptoms of severe renal insufficiency?
uremia
acidemia
volume overload
What do you start seeing an elevated BUN in CKD?
not until GFR is 75% of normal or less
What are some comorbidities in the perioperative associated with chronic renal failure?
hypervolemia
acidosis (decreased production of ammonia)
hyperkalemia
HTN
atherosclerosis
pulmonary edema
iron deficiency anemia
abnormal plt aggregation and prothrombin consumption
Which anesthesia drugs are impacted by renal insufficiency? Give examples
drugs that are highly ionized and eliminated unchanged in the urine like
muscle relaxants
cholinesterase inhibitors
thiazide diuretics
digoxin
antibiotics
What is a cystoscopy?
endoscopic procedure that involves scoping through the bladder
what is the purpose of a ureteroscopy?
Is the procedure of choice for mid/distal ureter or bilateral stones
What is another treatment option for treating ureter stones?
“MET” Medical Expulsive Therapy. Involves NSAIDS, aggressive fluid administration and CCB or alpha blockers
What is the purpose of alpha blockers like Tamsulosin in urinary stone treatment?
relax the ureter muscles making it easier for the stone to pass
What do calcium channel blockers do for urinary stone treatment?
These also reduce the tone of ureteral muscles
What are the surgical options for treating urinary tract stones?
stone basket vs. laser
shock wave lithotripsy
percutaneous nephrolithotomy
What is shock wave lithotripsy?
uses a device coupled with water and delivers a focused beam of low pressure pulse to breakup small to medium sized kidney stones
What are some absolute and relative contraindications to shock wave lithotripsy?
absolute: bleeding disorder, pregnancy
relative: large calcified renal aneurysms, untreated UTI, obstruction that is distal to renal calculi, pacemaker, ICD or neuro-stimulator, morbid obesity
What is percutaneous nephrolithotomy?
requires initial placement of ureteral stents, useful for large kidney stones. Less common than SWL.
What is an orchiectomy?
The spermatic cord is clamped, cut and sutured and either one or both (usually both) testicles are removed. Used to treat metastatic prostate cancer.
What is a hydrocelectomy?
The wall of the hydrocele (fluid filled sac around the testicles) is excised and edges are sutured to prevent reoccurrence of hydrocele (swelling of the scrotum)
How long does a patient have for surgery to prevent irreversible ischemic damage from testicular torsion?
6 hours or less
What are some benefits associated with circumcision?
If male babies have phimosis (tight foreskin) during development, circumcision may be necessary. Studies have shown a slight reduction in penile and prostate cancer risk with circumcision.
what surgical procedure can correct the birth defect in which the urethral opening is located on the underside of the penis?
Hypospadias repair
What procedure can be performed on a patient with squamous cell carcinoma that involves the penis and may involve the inguinal lymph nodes?
Penectomy
A penile block blocks which nerve?
Pudendal nerve (S2-S4)
What is a cystectomy and what is it used to treat?
removal of the bladder to treat simple benign conditions such as hemorrhagic and radiation cystitis. It can also be used to treat invasive bladder cancer.
