Anesthesia Management in Renal Failure 001

7/24/2019 Anesthesia Management in Renal Failure 001

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AnesthesiaManagement in Renal

Failure

By :dr. Yudi Hadinata

Consultant :dr. Wiwi Jaya Sp.An


2/20

!"HR#


3/20

Renal Fun$tions

!%$retion o&wastes

A$id BaseHomeostasis

#smolalityRegulation

Blood pressureregulation

HormoneSe$retion

'Morgan( )**+,


4/20

-enition/ A$ute Renal Failure :

/ -eterioration o& renal &un$tion o0er a period o& hours to days ')123)hrs,

/ Chroni$ Renal Failure

/ -eterioration persist more than 4 months with 5FR 6 +* 'm78min89.34m),

'Morgan( )**+ Hines( )**;,


5/20

-iagnosis

"ulmonary dyspnea( 7ung edema( hypo%emia

Cardio0as$ular Hypertension( CHF( 7alemia( hyperphosphatemia( hypermagnesium( hypoeruri$emia(

hypo$al$emia( meta=oli$ a$idosis.

Renal Ba$> pain( olygouria( diuresis( anuria( urogenital sign ? symptom

Anamnesis "hysi$al e%am 7a=oratoryndings

'Hines( )**;,


6/20

RENAL

FAILURE


7/20

-iagnosis

/ Creatinine le0el/ Male @6 Female '*.;29.4 @6 *.+29, gr8dl

/ Redu$e 5FR '5lomerular Filtration Rate,

/ 5FR de$rease 9 e0ery year a&ter )nd de$ade

Creatinine $learan$e : '91*2age, % lean=ody weight 3) % plasma $reatinineFemale ' *.;,

'Morgan( )**+,


8/20

Correlation =etween Creatinine and 5FR

'Morgan( )**+,


9/20

"eri$arditis

CoagulopathyRe&ra$tory 5D

symptom-rug Do%i$ity

Fluid #0erloadHyper>alemia

Se0ere A$idosis!n$ephalopathy

'Morgan( )**+,


10/20

"reoperati0e !0aluation

Renal-isease

"rogressing

-iminishing

Sta=le

Ereum8Creat

inine

Clini$al !0aluationRespiratory

Hemodynami$

Erine "rodu$tion

7a=oratory ResultH=( !le$trolyte( BD8CD( "D8A"DD

Hemodialy

sis'Morgan( )**+Hines( )**;,


11/20

nput#utpu

t

-ietaryinta>e

< uid

Erine

nsensi=lewater loss

Fluid Management in Renal Failure

BleedingBlood

produ$ts


12/20

Choosing the drug &or anesthesia G

Class o& drug Renal e%$retion"artially renal

e%$retion

ndu$tion drug 2 Bar=iturates

Mus$le rela%ant 5allamine( meto$urine "an$uronium(0e$uronium

Cholinesteraseinhi=itor 2

eostigmin(!drophonium

Cardio0as$ular drugs -igo%in( notropes

Atropine(

5ly$opyrollate(milrinone(ydralaine

Antimi$ro=ialsAminogly$osides( 0an$omy$in(

$ephalosporin( peni$illinSul&onamides

'MillerIs anesthesia( )**,


13/20

ntra0enous ? nhalation Anesthesia-rugs in Renal Failure

Dype o& -rugs -rugs Warning -ose

ntra0enous "ropo&ol adustment 92) mg8KgBW

!tomidate adustment*.)2

*.1mg8KgBW

Dhiopenthal adustment )24mg8KgBW

Ketamine LHypertension

nhalation souran sa&e

-esuran sa&e

Se0ouran Do%i$ 'Compound A,

Halotan Do%i$ 'Fluoride,

!nuran Do%i$ 'Fluoride,

)* Care&ull with anemia

#ther drugs 7ido$ain depends 929. mg8KgBW

Benodiaepin A$$umulation'Morgan( )**+ Hines( )**;,


14/20

Dype o& -rugs -rugs Warning -ose

#pioid Analgeti$s Fentanyl Hepati$ $learan$e ) 2 9* ug8Kg

Remi&entanyl Hepati$ $learan$e 9 u8Kg

Sul&entanyl Hepati$ $learan$e *.)24* ug8Kg

Al&entanyl Hepati$ $learan$e ;29** ug8Kg

Morphine Meta=oli$ A$$umulation *.9 2 9 mg8Kg

Meperidine Meta=oli$ A$$umulation ).2mg 8 Kg

'Morgan( )**+ Hines( )**;,


15/20

Mus$le Rela%antMus$le

rela%ant

Renal e%$retion

', -ose 'Mg8KgBW,

Mi0a$urium 6 9* *.9

Atra$urium 9* *.1

Ro$uronium 9* *.+

e( )**+ Morgan( )**+,


16/20

Con$lusion

5ood#ut$ome

"reoperati0ee0aluation

Sa&e -rugs

Monitoring"ost operati0eManagement


17/20

DHAK Y#E


18/20


19/20


20/20

Hyper>alemia/ Mild . 2 + mmol87

/ Moderate +.923 mmol87

/ Se0ere @ 3 mmol87

/ Signs :

/ Fatigue( wea>ness( parasthesia( paralysis

/ !C5 : "ea>ed D wa0e( prolonged "R( widened PRS( loss "wa0e( asystole

/ Dreatment :

/ Cal$ium glu$onate 9* '9* $$ o0er ) minutes,

/ nsulin 9* E O -* *$$ 22@ o0er 4*2+* minutes

/ -ialysis

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Anesthesia Management in Renal Failure 001