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Principles semester 2 > Neuro - anesthetic implications > Flashcards

Neuro - anesthetic implications Flashcards

exam 1

1
Q

Average CBF in adults

A

750 mL/min (15-20% of CO)

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2
Q

Rate of CSF production

A

15-20 mL/hr

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3
Q

total volume of CSF in system

A

150 mL

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4
Q

Spinal cord and brain blood supply

A

often have redundancy

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5
Q

Only artery of spinal chord that is not redundant

A

Artery of Adamkiewicz (Enters SC at T7 and suplies lumbosacral section)

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6
Q

SCPP level recomendations

A

> 40

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7
Q

Most important extrinsic factor influencing autoregulation

Key regulator or CBF

A

PaCO2

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8
Q

Intracranial HTN

A

sustained ICP 20-25 mmHg or higher

*some texts say 15 mmHg

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9
Q

Nitrous with neuro?

A

NO

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10
Q

Volatiles and neuro

A

give 0.5 MAC because all volatiles interfere with autoregulation

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11
Q

Ketamine a vasoconstrictor/vasodilator?

A

vasodilator and should be avoided

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12
Q

Circulatory steal phenomenon

A

arterioles in ischemic areas are maximally dilated and will not respond to vasodilators

so other vessels vasodilate and get blood instead

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13
Q

Fluid management: avoid

A
  1. dextrose
  2. hespan
  3. dextran

use NS

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14
Q

What agents are associated with isoelectric EEG changes?

A
  1. propofol
  2. isoflurane
  3. thiopental
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15
Q

Somatasensory evoked potentials (SSEP) monitors

A

ascending pathway (peripheral to brain)

tells us if there is an intact pathway from peripheral to spinal cord

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16
Q

SSEP anesthetic considerations

A
  1. Need goo mAP for good signals
  2. 0.5 MAC because SSEP is decreased with volatiles

*communicate what you give because monitoring is happening

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17
Q

Motor evoked potentials (MEP)

A

Monitors descending pathway, represents integrity of autonomic areas of spinal cord

stim applied to different areas, usually with TOF

18
Q

Motor evoked potentials (MEP) anesthetic consideration

A
  1. No muscle relaxant during case
  2. affected by hypothermia, hypoxia, hypotension
19
Q

BRainstem auditory evoked potentials (BAEP) does what?

A

monitor 8th cranial nerve during surgery that puts auditory nerve at risk

20
Q

Visual Evoked Potentials (VEP) does what?

A

Monitors visual pathways from retina via optic nerve

21
Q

what is the LEAST (barely) sensitive to anesthetics?

A

BAEP (brainstem auditory evoked potentials)

22
Q

What is the MOST sensitive to anesthetic agents?

A

VEP (Visual evoked potentials)

23
Q

Sensitivity to anesthetics in orders (evoked potential procedures)

A

VEP>MEP>SSEP>BAEP

24
Q

Craniotomy induction/intubation consideration

A

smooth and gentle! Don’t want to stimulate

25
Q

What is very common after craniotomy?

A

PONV

26
Q

Craniotomy emergence considerations

A

Smooth wake up (dont want to stimulate) - prevent bucking/coughing

want quick emergence for early neuro assessment

27
Q

MAP decreases (positioning)

A

decreases 0/7mm Hg/cm above heart (or 1.5mm Hg / inch)

28
Q

In sitting procedures, MAP should be at

A

head level

29
Q

Venous embolism and sitting

A

20-40% incidence rate

do not use nitrous

30
Q

Most sensitive monitor for Venous air embolism

A

TEE (invasive)
pre-cordial doppler (non invasive)

31
Q

Earliest sign of Venous air embolism

A

Sudden drop in ETCO2

then overall decompensation

32
Q

Main treatment goal of venous air embolism

A

Stop entrainment of air!

33
Q

Steps in venous air embolism treatment:

A
  1. Notify surgeon, floods field with NS
  2. Give 100% O2
  3. Place pt in L Lateral position with head down (Durant maneuver)
  4. aspirate air from R atrium if you have central line
34
Q

Postoperative vision loss risk

A

prone spinal surgeries

35
Q

Prevention postoperative visual loss

A
  1. appropriate position
  2. avoid eye compression
  3. MAP 60-70 to maintain BF to eyeballs
36
Q

Once patient is positioned in sterotactic brain procedure (3D imaging):

A

do not touch patient

37
Q

Ketamine and surgery to control seizures

A

avoid - activates seizures

38
Q

The only truly reliable neuro exam for craniotomy is

A

an awake patient

allows for intra op speech, motor and sensory testing

39
Q

Inclusions for awake craniotomy (3):

A
  1. normal airway exm
  2. able to lie still for extended period of time
  3. cooperative
40
Q

Risk of transphenoidal hypophysectomy procedures

A

massive hemorrhage

(via nose)

Principles semester 2 (17 decks)

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