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Fa: Sim 3 > 10. Neuro > Flashcards

10. Neuro Flashcards

1
Q

cerebral O2 consumption

A

20%

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2
Q

CMRO2

A

3-8 mL/100g/min
or 50 mL/min

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3
Q

where is CMRO2 the highest?

A

grey matter

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4
Q

what % of brain is gray?

A

40%

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5
Q

what % ofthe brain is white?

A

60%

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6
Q

total cerebral blood flow

A

15-20% of total CO

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7
Q

what ensures cerebral perfusion

A

redundancy via collateral flow in the circle of willis

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8
Q

CPP =

A

CPP = MAP - ICP
or
CPP = MAP - CVP

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9
Q

normal CPP

A

80-100 mmHg

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10
Q

cerebral autoregulation

A

60-160 mmHg

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11
Q

what do CPP < 50 mmHg indicate?

A

slowing EEG

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12
Q

cerebral PaCO2

A

20-80 mmHg

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13
Q

what crosses BBB

A

CO2

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14
Q

what does not cross BBB

A

ions

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15
Q

does met acidosis affect CBF

A

no

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16
Q

what is hypothermia impact on CBF and CMRO2

A

decr CBF
decr CMRO2

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17
Q

decr 10c causes

A

50% decr in CMRO2

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18
Q

incr 10c causes

A

2x CMRO2

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19
Q

what is the main determinent of viscosity?

A

HCt

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20
Q

what impacts tight junctions

A

size
charge
lipid solubility
protein binding

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21
Q

where is CSF produced

A

choroid plexus
ependymal cells of ventricles
CBF leak

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22
Q

CSF production per day

A

500 mL/day

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23
Q

CSF total volume

A

150 mL

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24
Q

CSF is _____ to plasma

A

isotonic to plasma

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25
Q

incr ICP compensatory mechanisms

A

CSF displace to spinal cord
incr CSF absorb
decr CSF production
decr cerebral blood vol

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26
Q

incr ICP can be indicated by what on radiology scans

A

> 0.5cm midline shift

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27
Q

midline shift is measures off of the

A

corpus collosum

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28
Q

normal CSF pressure

A

10 mmHg

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29
Q

what ICP triggers decr in cerebral blood vol?

A

ICP > 60 mmHg

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30
Q

iso CMR

A

decr

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31
Q

iso CBF

A

incr

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32
Q

iso CSF production

A

no change

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33
Q

iso CSF absorb

A

incr

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34
Q

iso CBV

A

incr

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35
Q

iso ICP

A

incr

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36
Q

des CMR

A

decr

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37
Q

des CBF

A

incr

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38
Q

des CSF

A

incr

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39
Q

des CSF absorb

A

decr

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40
Q

des CBV

A

incr

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41
Q

des ICP

A

incr

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42
Q

sevo CMR

A

decr

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43
Q

sevo CBF

A

incr

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44
Q

sevo CBV

A

incr

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45
Q

sevo ICP

A

incr

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46
Q

nitrous CMR

A

decr

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47
Q

nitrous CBF

A

incr

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48
Q

nitrous CSF

A

no change

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49
Q

nitrous CSF

A

no change

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50
Q

nitrous CBV

A

no change

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51
Q

nitrous ICP

A

incr

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52
Q

barbituates CMR

A

decr

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53
Q

barbituates CBF

A

decr

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54
Q

barbituates CSF

A

no change

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55
Q

barbituates CSF absorb

A

incr

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56
Q

barbituates CBV

A

decr

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57
Q

barbituates ICP

A

decr

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58
Q

etomidate CMR

A

decr

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59
Q

etomidate CBF

A

decr

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60
Q

etomindate CSF

A

no chagne

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61
Q

etomidate CSF absorb

A

incr

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62
Q

etomidate CBV

A

decr

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63
Q

etomidate ICP

A

decr

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64
Q

propofol CMR

A

decr

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65
Q

propofol CBF

A

decr

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66
Q

propofol CBV

A

decr

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67
Q

propofol ICP

A

decr

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68
Q

benzos CMR

A

decr

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69
Q

denzos CBF

A

decr

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70
Q

benzos CSF

A

no change

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71
Q

benzos CSF absorb

A

incr

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72
Q

benzos CBV

A

decr

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73
Q

benzos ICP

A

decr

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74
Q

ketamine CMR

A

no change

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75
Q

ketamine CBF

A

incrketa

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76
Q

ketamine CSF

A

no change

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77
Q

ketamine CSF absorb

A

decr

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78
Q

ketamine CBV

A

incr

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79
Q

ketamine ICP

A

incr

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80
Q

opioids CMR

A

no change

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81
Q

what do opioids change?

A

incr CSF absorption

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82
Q

lidocaine CMR

A

decr

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83
Q

lidocaine CBR

A

decr

84
Q

lidocaine CBV

A

decr

85
Q

lidociane ICP

A

decr

86
Q

which inhaled agent has greatest effect on autoregulation

A

halothane

87
Q

which inhaled agent has best CSF production/absorption dynamic

A

iso

88
Q

most cerebral protective drug

A

barbituates

89
Q

which drug can have possible seizure activity

A

etomidate

90
Q

isoelectric

A

minimal brain activity

91
Q

luxury perfusion

A

decr cerebral met demand
incr CBF

92
Q

circ steal

A

ischemic areas max vasodilation
agents incr CBF
blood shunted away from ischemic areas

93
Q

main goal for cerebral protection

A

incr O2 delivery
decr further decline

94
Q

hypothermia effects

A

decr metabolic and basal rates

95
Q

anesthetic effects

A

decr metabolic rates

96
Q

nimodipine effects

A

prevents vasospasm

97
Q

cerebral protection: carbia

A

normocarbia

98
Q

cerebral protection avoid

A

avoid:
hTN
elevated CVPs
hyperglycemia

99
Q

eeg

A

summation of excitatory and inhibitory postsynaptic potentials of cerebral cortex

100
Q

EEG uses

A

ID inadequate BF to cortex
guide to reduction of cerebral metabolism
predict neuro outcome after brain injury
guage depth of anesthetic

101
Q

fastes human brain waves

A

gamma
32-100Hz

102
Q

slowest brain waves

A

delta
0.5-4 hz

103
Q

brain wave

A

fast
gamma
beta
alpha
theta
delta
slow

104
Q

eeg should be correlated with what

A

EKG

105
Q

EEG changes with age

A

amplitude decr with ageq

106
Q

ischemia on EEG

A

slow freq
preserved amplitude

107
Q

CBF ischemic threshold

A

18

108
Q

CBF infarction threshold

A

12

109
Q

CBF normal

A

35-50

110
Q

what is the difference between BIS 2 or 4 channel

A

BIS 4 can differentiate between hemispheric differences

111
Q

BIS isoelectric

A

0

112
Q

BIS GA

A

40-60

113
Q

BIS MAC

A

60-80

114
Q

BIS awake

A

100

115
Q

BIS liitations

A

agents
age
hypothermia
neuro impairment
interference

116
Q

ketamine ____ electric activity

A

incr

117
Q

evoked potentials test

A

neural pathways
subcortical function

118
Q

evoked potentials look at

A

amplitude
latency

119
Q

ampliotude

A

voltage of signal

120
Q

latency

A

time to illicit signal

121
Q

Sensory evoked potentials

A

SSEPs
BAEPs - click
VEPs - goggles

122
Q

which sensory evoked potentials are monitored with MEPs

A

SSEPs

123
Q

which monitoring can you paralyze

A

sensory evoked potentials can be paralyzed

124
Q

MEPs

A

TMEPs
SMEPs

125
Q

stimulus needed for transcrania motors

A

> 400V via screw needle

126
Q

who initiates spinal motor evoked potentials

A

surgeon directly stimualtes spinal cord

127
Q

generally, all sedative and inhalational agents _____ amplitude and ________ latency

A

decr amplitude
incr latency

128
Q

burst suppression dosing inhalational

A

> 1.5 MAC

129
Q

which drugs cannot achieve burst suppression even at high doses?

A

ketamine
benzos
opiates
nitrous

130
Q

IV vs inhalational effect on evoked potentials

A

IV have less effect than inhalational

131
Q

combination of drugs effect on evoked potentials

A

combination of drugs is additive

132
Q

which evoked potentials are resistant to the effects of anesthetic gases

A

subcortical SEPs
(bc they have less synapses)

133
Q

which VA is more inhibitory at higher doses

A

Des is more inhibitory than sevo at higher doses

134
Q

hypoxia EEG

A

slows frequency
absence of electrical activity

135
Q

hypotension EEG

A

bilateral
non specific

136
Q

hypothermia EEG

A

dose depended suppression

137
Q

what temperature has complete suppression

A

15-18C

138
Q

hypotension effect on SSEPs

A

decr in amplitude
no change latency

139
Q

hypotension effect on BAEPs

A

no change (high resistance)

140
Q

hypothermia effect on evoked potentials

A

decr amplitude
incr latency

141
Q

radiculopathy

A

nerve root compression

142
Q

spondylosis

A

wear on bone or cartilage

143
Q

which spine surgery requires vascular surgeon

A

ALIF

144
Q

which spine surgery can cause tracheal compression and damage to RLN

A

ACDF

145
Q

POVL

A

perioperative vision loss

146
Q

POVL risk factors

A

time
large EBL
hTN
DM
obesity
smoking

147
Q

neurogenic shock

A

trauma with transection cephalad to T6
disrupts descending sympa tracts

148
Q

neurogenic shock has unopposed _____

A

unopposed parasympathetic activity
== HD instability

149
Q

treat neurogenic shock

A

volume
+ norepi / vasopressin

150
Q

AH T6

A

85%

151
Q

AH T10

A

rare

152
Q

AH management

A

decr afferent activity

153
Q

how do you decr afferent activity in AH

A

regional anesthesia
high degree of anesthesia

154
Q

AH adjuncts

A

clevidipine
hydralazine
propofol

155
Q

AH and AD present with

A

unihibited sympathetic response below transection
reflex brady
cutaneous vasodilation
high afterload state

156
Q

high afterload symptoms

A

pulm edema
LV overload
seizure
arrythmias

157
Q

supratentorial

A

higher brain function

158
Q

supratentorial mass SE

A

incr seizures
hemiplegia
aphasia

159
Q

infratentorial

A

balance
proprioception

160
Q

infratentorial mass SE

A

cerebellar dysfunction
brainstem compression

161
Q

cerebellar dysfuncrtion SE

A

ataxia
nystagmus
dysarthria

162
Q

brainstem compression SE

A

cranial nerve palsy
altered consciousness
resp abnormalities

163
Q

oldes structure in brain

A

brainstem

164
Q

cranial mass pre-op exams

A

mentation
sensory
motor

165
Q

what should you avoid in cranial mass excision

A

pre-op versed
- obscures neural exam
- incr hypercarbia == incr ICP

166
Q

cranial mass pts will have what abnormal labs

A

hyperglycemia
hypernatremia

167
Q

ventriculostomy

A

drainage tube that surgeon places into ventricle of brain

168
Q

ventriculostomy functions

A

drain CSF
monitory CSF pressure (measure ICP)

169
Q

venticulostomy height

A

level of external acoustic meatus

170
Q

what pressure is needed for ventriculostomy to drain

A

10 cmH2O

171
Q

which paralytic can incr ICP

A

sux
(transient)

172
Q

fluids for cranial mass pt

A

limited to prevent cerebral edema

173
Q

HTN in cerebral pts

A

incr brain mass
incr EBL

174
Q

hTN in cerebral pts

A

incr intra-op ischemia

175
Q

hypocarbia ____ CBF

A

decr CBF

176
Q

hypercarbia _____ CBF

A

incr CBF

177
Q

hyperventilation will _____ CBF and ICP

A

transiently decr CBF and ICP for 6-8 hrs

178
Q

biot

A

deep breath with periods of apnea

179
Q

cheyne-stokes

A

varying periods of breaths

180
Q

biot causes

A

spinal meningitis
head injury

181
Q

cheyne stokes causes

A

brain tumors
injuries

182
Q

brain stem functions

A

breathing
consciousness
BP/HR
sleep

183
Q

functional/stereotactic procedures are used to treat

A

parkinsons
epilepsy
lesions (broca area)

184
Q

where do aneurysms present

A

arterial bifucations

185
Q

mortality for cerebral aneurysm rupture

A

33%

186
Q

cerebral aneurysm treatment

A

coiling
clipping

187
Q

AV malvormation

A

fistula in brain

188
Q

AV malformation SE

A

extensive blood loss

189
Q

anuerysm clipping requires a

A

type and cross
2 units of PRBCs in room
art line

190
Q

MAP goal for unruptured aneurysm

A

60-80 mmHg

191
Q

EtCO2 goal for unruptured aneyrusym

A

35 mmHg
(normocarbia)

192
Q

temporary aneurysm clipping requires

A

cool pts to 35-45 deg

193
Q

what is a temporary clip trial

A

to test how well the pt tolerates the clipping

194
Q

what does anesthesia need to ensure prior to temp clipping

A

achieve burst suppression
circ arrest (longer duration)

195
Q

temp clip MAP

A

90-100 mmHg

196
Q

temp clip removed MAP

A

60-80 mmHg

197
Q

what can be used to ensure burst suppression

A

150-250 mcg/kg/min propofol

198
Q

what is ICG used for

A

to confirm flows after clipping

199
Q

ICG dose

A

25 mg into 10 mL NS
2.5 mg/mL

200
Q

final clipping MAP

A

70-90 mmHg

201
Q

aneurysm rupture MAP

A

40-50 mmHg

202
Q

what should you give if surgeon cannot contain ruptures

A

adenosine
PRBCs

203
Q

rescue adenosine dose

A

0.3-0.4 mg/kg

204
Q

what can you give for brain relaxation

A

decadron
mannitol
lasix
hyperventilation
hypertonic saline

205
Q

when is keppra needed

A

anti-convulsant coverage during ruptured aneurysma

206
Q

AVM higher flow rate =

A

higher flow rate = higher bleeding risk

Fa: Sim 3 (15 decks)

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