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Principles 4 > Intro to Neuro Anesthesia PPT > Flashcards

Intro to Neuro Anesthesia PPT Flashcards

1
Q

How much does the adult brain weigh?

A

1350gm (2% of tbw)

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2
Q

What is CBF? (flow)

A

45-55 ml/100g/min

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3
Q

How do you calculate CBF?

A

CBF= CPP/CVR

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4
Q

How much of your cardiac output goes to the brain?

A

12-15%

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5
Q

what is the CMRO2 of the brain?

A

3/5ml/100g/min (20% of total O2 consumption)

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6
Q

How do you calculate CPP?

A

CPP=MAP-ICP

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7
Q

What is CVR? (flow)

A

1.5-2.1 mmHg/100g/min/ml

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8
Q

How do changes in the CBF change CMRO2?

A

They are directly coupled.

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9
Q

What happens to CMRO2 when you sleep?

A

it decreases

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10
Q

For every 1 degree celsius decrease in body temp below 37 how is CBF effected?

A

decreases 7%

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11
Q

How do volatile anesthetics effect CMRO2?

A

reduces it

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12
Q

Rank different induction medications in order of decreasing CMRO2….

A

thiopental>etomidate>propofol

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13
Q

What MAP is required to maintain CBF?

A

70-150

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14
Q

What is the Myogenic Hypothesis?

A

transient changes in CBF (3-4 min) due to rapid changes in MAP. Most likely due to direct changes in the tone of the vascular smooth muscle.

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15
Q

Neurogenic innervation includes

A

cholinergic, adrenergic, serotonin, and vasoactive intestinal peptide.

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16
Q

Neurogenic influence is greatest on?

A

large cerebral arteries.

17
Q

How does HCT and viscosity effect CBF?

A

decreases CBF when HCT is >55%

18
Q

What type of pt are we concerned with high HCT?

A

smokers

19
Q

In case you didn’t do my Nag questions….

what is an astrocyte?

A

support, metabolic function, nutritive functions

20
Q

ependymal cells

A

lines cavities of the CNS and makes up the walls of the ventricles

21
Q

microglia cells

A

phagocytosis

22
Q

oligodendrocytes

A

insulation for axons- myelin sheath in brain and spinal cord

23
Q

schwann cells

A

insulation- myelin sheath in peripheral nervous system

24
Q

Tell me about the BBB

A

effective isolation for the brain and spinal cord, tight junctions between cells.

25
Q

What portions of the brain are exempt from the BBB?

A

area postrema, pituitary gland, pineal gland, choroid plexus, and parts of the the hypothalamus

26
Q

VAAs and increased CBF rank em

A

halothane»enflurane>desflurane=idoflurane>sevoflurane

27
Q

How does N2O effect the brain?

A

increases CBF, ICP, and CMRo2

28
Q

How does Ketamine effect PaCO2, CBF and ICP without controlled ventilation?

A

increased!!!!

29
Q

How do you minimize the effects of ketamine?

A

give it with another sedative or anesthetics and with controlled ventilation

30
Q

What do benzos and barbs do to CMRO2 and CBF?

A

reduce them in a dose dependent fashion

31
Q

Do narcs effect CBF and CRMO2?

A

NOPE

32
Q

Why do NDMR matter for the brain?

A

only poor effect is from histamine release.

33
Q

What does succs do for the brain?

A

increases ICP in light pts.
increases CBF for cerebral activation from muscle spindle apparatus
try and defasiculate if going to RSI

34
Q

4 determinants of CBF

A

brain (12%), intracellular water (78%), CSF (~75ml), and blood (~50ml).
total is 1200-1500ml

35
Q

What is the normal range of ICP?

A

5-15

36
Q

What is considered intracranial HTN

A

sustained ICP >15-20

37
Q

What happens when ICP is over 30?

A

CBF progressively decreases ->ischemia -> cerebral edema -> increased ICP-> CBF decreases-> more ischemia -> more edema….. vicious cycle.

38
Q

In elevated ICP- what happens to the CSF?

A

CSF volume will decreases- or translocate to the spinal compartment.

39
Q

What are some signs of ICP?

A 
NV
HTN
Bradycardia
Personality changes
Altered LOC
Altered patterns of breathing
Papilledema

Principles 4 (20 decks)

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