Pnr slides of renal modified

RENAL PRESERVATION ARF AND ITS MANAGEMENT Dr.P.Narasimha Reddy M.D.,D.A. Professor and HOD Department of Anaesthesiology NARAYANA Medical College NELLORE - A.P.

DEFINITION ,[object Object],[object Object],[object Object],[object Object],[object Object]

BASIC CONCEPTS OF ANATOMY AND PHYSIOLOGY OF KIDNEY ,[object Object],[object Object],[object Object],[object Object]

PATIENT FACTORS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

HIGH RISK SURGICAL PROCEDURES ,[object Object],[object Object],[object Object],[object Object],[object Object]

NEPHROTOXINS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

NEPHROTOXINS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PRE OP OPTIMIZATION: 1) EARLY IDENTIFICATION OF THE PROBLEM : INTRAVASCULAR VOLUME STATUS-MAINTAINANCE OF EFFECTIVE INTRAVASCULAR VOLUME, I.V. FLUIDS MAY BE STARTED ONE DAY BEFORE SURGERY, HEMODYNAMIC MONITORING-- CVP, PA AND WEDGE PRESSURES, CI, SVR ARE HELPFUL IN OPTIMIZING THE FLUID VOLUME. CONTINOUS BP MONITORING AND MAINTAINING IT IN NORMAL RANGE. URINARY CATHETERIZATION (URINARY OUT PUT IS A POOR MONITOR OF KIDNEY FUNCTION). 2) ASSOCIATED MEDICAL, SURGICAL AND NEPHROTOXIC EXPOSURES: ASSOCIATED MEDICAL CONDITIONS TO BE ATTENDED, TIME OF SURGERY IS MINIMIZED, SPACING OF PROCEDURES AND AVOIDING NEPHROTOXIC AGENTS. 3) ANAESTHETIC PLAN THAT EMPHASISES RENAL PRESERVATION . STRATEGIES TO PREVENT P.O. ARF

PHARMACOLOGICAL STRATEGIES ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],CALCIUM CHANNEL BLOCKERS

CALCIUM CHANNEL BLOCKERS (Cont’d) ,[object Object],[object Object],[object Object],[object Object]

CALCIUM CHANNEL BLOCKERS (Cont’d) ,[object Object],[object Object],[object Object]

PROSTAGLANDINS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ATRIAL NATRIURETIC PEPTIDE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ATRIAL NATRIURETIC PEPTIDE (Cont’d) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

DOPAMINE – 1 AGONISTS ,[object Object],[object Object]

DOPAMINE – 1 AGONISTS (Cont’d) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

MODULATION OF COMPLEMENT SYSTEM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

21 – AMINO STEROIDS (TIRILIZAD) ,[object Object],[object Object],[object Object],[object Object]

ALPHA MELANOCYTE STIMULATING HORMONE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

DOPAMINE ,[object Object],[object Object],[object Object],[object Object],[object Object]

DOPAMINE (Cont’d) ,[object Object],[object Object]

EFFECTS OF DOPAMINE ON RENAL PHYSIOLOGY ,[object Object],[object Object]

FUROSEMIDE ,[object Object],[object Object],[object Object],[object Object],[object Object]

MANNITOL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

VOLUME LOADING ,[object Object],[object Object],[object Object],[object Object],[object Object]

MANAGEMENT OF ARF IN THE POST-OPERATIVE PERIOD ,[object Object],[object Object],[object Object],[object Object],[object Object]

PATHOPHYSIOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

SEVERITY SCORING - ARF ( CLEVELAND CLINIC SCORING) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

MANAGEMENT ,[object Object],[object Object],[object Object]

MANAGEMENT (Cont’d…) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CONSERVATIVE /MEDICAL MANAGEMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

HYPERKALEMIA (MANAGEMENT Contd) ,[object Object],[object Object],[object Object],[object Object]

UREMIA MANAGEMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

HYPER / HYPOTENSION MANAGEMENT ,[object Object],[object Object],[object Object]

METABOLIC ACIDOSIS MANAGEMENT ,[object Object],[object Object],[object Object]

ANAEMIA ,[object Object],[object Object],[object Object],[object Object],[object Object]

RENAL REPLACEMENT THERAPY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

INTERMITTENT HEMODIALYSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CONTINUOUS HEMOFILTRATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PERITONEAL DIALYSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

REFERENCES ,[object Object],[object Object],[object Object]

Pnr slides of renal modified

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Pnr slides of renal modified