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1
Q

What is the most common cause of perioperative vision loss?

A

Ischemic optic neuropathy

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2
Q

What is the most common perioperative eye complication?

A

corneal abrasion

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3
Q

When does vision loss from ION occur?

A

Usually within 24-48 hours of surgery

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4
Q

Is ION painful?

A

No, it is not associated with pain

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5
Q

What are the procedural risk factors for developing ION?

A

Prone position
Wilson frame
Long anesthesia
Blood loss
Insufficient colloids with resuscitation
Hypotension

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6
Q

Which procedures carry the highest risk for ION?

A

Spinal surgery
CPB
Radical neck dissection

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7
Q

What is CRAO?

A

Central Retinal Artery Occlusion

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8
Q

What’s the difference between ION and CRAO?

A

ION is a problem with the nerve ischemia, usually due to venous congestion

CRAO is a problem with blood vessel occlusion

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9
Q

What are the risk factors for CRAO?

A

Horse shoe headrest
Using nitrous after retinal bubble placement
Embolism from CPB

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10
Q

Most brain tumors arise from _______ cells

A

glial

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11
Q

What is the role of astrocytes?

A

the most abundant type of glial cell
They regulate the metabolic environment and repair neurons after injury

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12
Q

What is the role of ependymal cells?

A

CSF production

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13
Q

What is the role of oligodendrocytes?

A

Form the myelin sheath in the CNS

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14
Q

What is the role of Schwann cells?

A

Form the myelin sheath in the PNS

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15
Q

What is the role of microglia?

A

Act as macrophages and phagocytize neuronal debris

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16
Q

What is Broca’s area?

A

Frontal lobe
motor control of speech

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17
Q

What is Wernicke’s area?

A

Temporal lobe
Understanding of speech

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18
Q

What structures are located in the diencephalon?

A
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19
Q
A
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20
Q

What cranial nerve is most likely to be compressed by a pituitary tumor?

A

Optic

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21
Q

What is the primary site of CSF production?

A

Choroid plexus

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22
Q

What is the primary site of CSF reabsorption?

A

Arachnoid villi

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23
Q

The BBB is composed of ______ junctions

A

tight junctions

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24
Q

What is approximate normal CSF volume?

A

About 150 ml

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25
How quickly is CSF produced?
About 30ml/hr
26
Where in the brain is the BBB NOT present?
Chemoreceptor Trigger Zone Hypothalamus Pineal Gland Posterior Pituitary Choroid Plexus
27
What is the calculation for cerebral blood flow?
28
What percent of the cardiac output goes to the brain?
15%
29
What is a normal CMRO2?
3.0-3.8 ml/O2/100g Tissue
30
What percentage of brain oxygen is used for electrical activity?
60% The other 40% maintains cellular integrity
31
How does temperature impact CMRO2?
Decreases 7% for every 1 degree C drop
32
CMRO2 is decreased by:
- hypothermia - halogenated anesth. - propofol - etomidate - barbiturates
33
CMRO2 is increased by:
- hyperthermia - ketamine - nitrous - seizures
34
What is the calculation for cerebral perfusion pressure?
35
Cerebral perfusion is generally autoregulated. What things abolish cerebral autoregulation?
- Tumors - Trauma - Volatile anesthetics
36
The brain is able to autoregulated when the CPP is between _______ and ______
50 to 150 mmHg
37
CPP autoregulation is generally maintained when the MAP is between ______ and _______
60 - 160
38
Which patients are at greatest risk of developing cerebral ischemia intraop?
Patients with chronic hypertension
39
For every 1mmHg increase in PaCO2, CBF will:
increase by 1-2 ml/100g tissue
40
For every 1mmHg decrease in PaCO2, CBF will:
decrease by 1-2 ml/100g tissue
41
Maximal cerebral vasodilation occurs at a PaCO2 of:
80-100 mmHg
42
Maximal cerebral vasoconstriction occurs at a PaCO2 of:
~ 25 mmHg
43
The relationship between CBF and PaCO2 is:
linear
44
Will a patient with metabolic acidosis display changes in CBF?
NO! Cerebral response is based on H+ ions in the CSF, but only CO2 can cross the BBB. Once across, it dissociates back into H+ ions
45
What is the Robinhood effect?
Using hyperventilation to increase cerebral vasoconstriction in healthy tissue to cause increased perfusion to ischemic tissue (which is permanently vasodilated). Nice in theory, but not supported by evidence
46
How does PaO2 impact CBF?
47
How does the CVP impact ICP?
48
What conditions impair venous drainage from the brain?
49
What is a normal ICP?
5-15 mmHg
50
Intracranial HTN occurs when ICP exceeds:
20 mmHg
51
Cushing's triad includes:
Hypertension Bradycardia Irregular Respirations
52
The most common site of herniation is:
at the temporal uncus
53
Why does herniation result in fixed and dilated pupils?
herniation applies pressure to CN III (Occulomotor)
54
What is pseudotumor cerebri?
a condition where ICP is reduced for no apparent reason
55
Which fluids should be avoided in patients with increased ICP?
Anything with Glucose In ischemic settings, any extra glucose in the brain is converted to lactic acid, making things worse
56
57
Anterior circulation in the brain is supplied by:
58
Posterior circulation of the brain is supplied by:
59
Venous blood from the cerebral cortex and cerebellum drains via:
The superior sagittal sinus and the dural sinuses
60
Venous blood from the basal brain structures drains via:
the inferior sagittal sinus, the vein of Galen, and the straight sinuses
61
Both of the brain's venous pathways converge at _______ and exit the brain via ________
the confluence of the sinuses the jugular veins
62
tPA must be given within _______ hours of an inschemic stroke
4.5 hours
63
In patients with ischemic stroke, what is the goal BP?
Their BP will likely be high in order to maintain CPP Just keep it below 185/110
64
What is the leading cause of morbidity and mortality after a SAH?
Vasospasm
65
What is the best prevention of vasospasm in patients with SAH?
The three H's: Hemodilution Hypervolemia Hypertension
66
What is the most common cause of SAH?
Aneurysm rupture, usually in the circle of willis
67
Why does Nimodipine reduce morbidity from vasospasm?
It does NOT relieve the spasm, BUT it does increase collateral flow
68
When a venous aneurysm ruptures, bleeding usually occurs in:
the subdural space
69
When an arterial aneurysm ruptures, bleeding usually occurs in:
the subarachnoid space
70
What is the treatment for SAH?
Endovascular coiling or clipping
71
What are the anesthesia goals when performing an aneurysm clipping or coiling?
Maintain SBP between 120 and 150
72
Patients with SAH are at risk for _________ syndrome
Cerebral salt wasting
73
What is Cerebral Salt wasting syndrome?
The brain releases natriuretic peptides, leading to sodium wasting by the kidney. Causes hyponatremia and hypovolemia Unlike SIADH, it does not cause hypervolemia
74
What are the two most common signs of cerebral vasospasm?
New neurological deficit Altered LOC
75
When is cerebral vasospasm most likely to occur?
Within 4-9 days of the SAH
76
What are anesthetic considerations in the patient with TBI?
CPP> 70 Hypertonic saline No steroids No nitrous No albumin No glucose
77
Status Epilepticus is defined as:
Seizure > 30 min OR 2 grand mal seizures without regaining consciousness in between
78
What are signs of a seizure under general anesthesia?
Tachycardia Hypertension Increased etCO2
79
Which IV anesthetic should be avoided in patients with seizures?
Ketamine
80
Which three IV anesthetics increase EEG activity and are used to locate seizure foci?
Etomidate Methohexital Alfentanil
81
How does carbamazepine impact hepatic enzymes?
Induces
82
How does valproic acid impact hepatic enzymes?
Inhibits
83
How does phenytoin impact hepatic enzymes?
Induces
84
How does gabapentin impact hepatic enzymes?
It doesn't. It's excreted unchanged by the kidneys
85
How does hepatic enzyme induction impact NMBA action?
It causes resistance, because NMBAs are being metabolized at a higher rate
86
What is the MOA of Valproic Acid, Carbamazepine, and Phenytoin?
Block voltage gated sodium channels, leading to membrane stabilization
87
Which anticonvulsant can cause purple glove syndrome?
Phenytoin, if it extravasates
88
Patients being treated for Alzheimer's may have increased sensitivity to which NMBA?
They are usually taking cholinesterase inhibitors, which slows the metabolism of succinylcholine, mivacurium, and ester LAs

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