6. Neuroanesthesia

Question 1

drugs that lower ICP

Answer 1

mannitol
hypertonic saline
furosemide
corticosteroids

Question 2

mannitol mech

Answer 2

hyperosmotic
pulls fluid from brain

Question 3

mannitol DOA

Answer 3

6 hrs

Question 4

after mannitol dose, when should ICP start decreasing?

Answer 4

within 30 mins

Question 5

mannitol max effect?

Answer 5

1-2 hrs

Question 6

mannitol tachyphylaxis

Answer 6

24-48 hrs

Question 7

mannitol SE

Answer 7

hyperosmolarity
hyponatremia
hypokalemai

Question 8

mannitol dose

Answer 8

0.25-0.5 g/kg IV

Question 9

mannitol goal serum osm

Answer 9

300-315 mOsm/L

Question 10

what serum osm should you stop mannitol?

Answer 10

320 mOsm/L

Question 11

what can happen with a larger initial dose of mannitol?

Answer 11

rebound incr in ICP

Question 12

mannitol monitoring

Answer 12

serum osmolarity
urine output
BP
electrolytes

Question 13

mannitol pts require a _______

Answer 13

intact BBB

Question 14

mannitol CI

Answer 14

TBI
HF
anuerysms
AV malformation
brain bleed

Question 15

hypertonic saline MOA

Answer 15

hyperosmotic
pulls fluid from brain

Question 16

hypertonic saline SE

Answer 16

serum hypernatremia

Question 17

hypernatremia is associated with

Answer 17

serum Na > 160 mEq/L causes:
renal injury
pulm edema
seizures
cardiac dysfunction

Question 18

hypertonic saline monitoring

Answer 18

serum Na
serum osmolarity

every 6 hrs***

Question 19

which has higher risk, hypertonic saline or mannitol?

Answer 19

hypertonic saline

Question 20

furosemide MOA

Answer 20

loop diuretic
blocking the sodium-potassium-chloride (Na-K-2Cl) cotransporter in the thick ascending limb of the loop of Henle in the kidney

Question 21

furosemide indication

Answer 21

pt w/symptoms of high IV volume
aid tolerance of mannitol/hypertonic in pt w/CHF/nephrotic syndrom

Question 22

corticosteroids are useful in what pts

Answer 22

lower ICP causedby localized vasogenic edema
(brain tumor / craniotomy)

Question 23

corticosteroids MOA

Answer 23

upregulation of expression of proteins responsible for tight junctions in BBB

Question 24

decadron dose

Answer 24

10 mg IV

Question 25

decadron taper

Answer 25

4 mg IM every 6 hrs
switch to PO

Question 26

decadron SE

Answer 26

hyperglycemia

Question 27

why is decadron better than hydrocortisone for ICP

Answer 27

decadron does not cause a mineralcortocoid effect
- no Na/H2O retention