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Miller's Anesthesia > 11. Cerebral Physiology > Flashcards

11. Cerebral Physiology Flashcards

1
Q

Dominant Jugular vein

A

65% Right

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2
Q

Circle of Willis

A

Anterior circulation from Internal carotids (x2)
Posterior from basilar artery

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3
Q

CSF production and absorption

A

Produce by choroid plexus. Reabsorbed by arachnoid granules
CSF production 450 ml/ day
CSF volume 150 ml

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4
Q

Cerebral blood flow

A

50 ml/100mg/min

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5
Q

PO2 in brain veins

A

40 mmHg

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6
Q

CBF and CMR. Grey vs white matter

A

Grey matter x 4 vs white

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7
Q

CBF autoregulated from ….
How much time take in case of rapid change in arterial pressure

A

From 70 - 150 MAP
Takes 3-4 min in case of rapid change (transient decrease in CBF)

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8
Q

Anesthetic drugs that increase CMR

A

Ketamine NO2

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9
Q

1 degree Celsius change CMR

A

6 - 7%

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10
Q

Autoregulation MAP and hypocapnia

A

More influence from Hypocapnia compared to MAP

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11
Q

The limit for an attenuated response of PCO2

A

25 mmHg

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12
Q

In case of hypotension (<66%) CO2 response

A

is abolished

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13
Q

In general, a decrease in CO2 affects CBF …

A

Decreases CBF

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14
Q

Lower limit autoregulation

A

From 33 as high as 108

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15
Q

In general, a decrease in MAP affects CBV …

A

Increase CBV to maintain flow

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16
Q

CBF and CBV

A

They run in parallel
CBV less magnitude in change compared to CBF

17
Q

Ketamine CBF MAP CMR

A

Increases all

18
Q

Drugs that decrease CBF and CMR

A

Thiopental the most
Prop > Etom > Dex > Fent > Diaz > Morph

19
Q

Vasodilation potency of vapors

A

Halo > Enof > Dexf > Isof > Sevo

20
Q

Scoline valid for RSI in TBI?

A

Yes. No changes in ICP (1 mg/kg)

21
Q

What to use to control seizures in status epilepticus?

A

Iso

22
Q

Use of mild Hypothermia

A

32-34, 24 h max
For cardiac arrest. For GCS <7

23
Q

When restored normotension in patient with cerebral ischemia

A

ASAP. 70-80 MAP

24
Q

MAC and CBF / CMR

A

0.5 Decrease both
1 CBF unchanged. CMR suppression
> 1 Decrease CMR, increase CBF

25
Q

MAP at CBF 25mg/100ml/min

A

25 mmHg

26
Q

CBF for EEG supression

A

15 ml/100mg/min

27
Q

CBF thresholds

A

< 20 Ischemia
< 15 penumbra
6-10 Irreversible damage

28
Q

Vasopressors and CBF

A

Nor / Phenylep No changes
Alpha 1 Midodrine increase velocity

29
Q

Most powerful predictor after ischemia

A

Glucose levels

30
Q

How to decrease rebound edema

A

Loop D (Bumetamide)

Miller's Anesthesia (43 decks)

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