Neuro Clinical Monitoring

Question 1

Which test of neuromuscular function consists of continuous stimulation for five seconds at 50 Hz or 100 Hz?

Answer 1

Tetanus

Question 2

What is the gold standard for measuring core body temperature?

Answer 2

Pulm Artery Cath. The most precise and accurate.

Question 3

Burst suppression is best characterized on an EEG as:

Answer 3

Alternating episodes of isoelectricty (0 or low voltage) and high voltage active oscillations on an EEG. Denotes minimal neuronal activity.

Question 4

A frequency of _______ characterizes alpha waves on an EEG and are present in an _____ patient

Answer 4

8-12Hz and alert patient

Question 5

A frequency of _______ characterizes beta waves on an EEG and are present in an _____ patient

Answer 5

13-25Hz
arousable state of sedation

Question 6

Loss of cortical electrical activity on an EEG is characterized by?

Answer 6

Complete loss of cortical electrical activity. present in unanesthetized comatose patients - poor prognosis

Question 7

Jugular venous oximetry monitoring is optimally measured at which vertebrae level?

Answer 7

C1-C2

Question 8

What neuro clinical monitoring can be done under anesthesia?

Answer 8

1. Cerebral Electrical Activity
2. Cerebral Blood Flow (CBF)
3. Cerebral Oxygen Content
4. Intracranial Pressure
5. Cerebral Metabolic Rate of Oxygen Consumption

Question 9

How is cerebral electrical activity monitored?

Answer 9

EEG and EVPs (evoked potentials)

Question 10

How is cerebral blood flow monitored?

Answer 10

Transcranial Doppler Ultrasound (TCD)

Question 11

How is cerebral oxygen content monitored?

Answer 11

NIRS
Near Infrared Spectrometry

Question 12

How is intracranial pressure monitored?

Answer 12

Intraventricular catheters and fiberoptic and intraparenchymal micro transducers

Question 13

How is cerebral metabolic rate of oxygen consumption (CMRO2) monitored?

Answer 13

JVO2 - jugular venous oximetry or intracerebral partial pressure of oxygen (pO2) electrodes

Question 14

As ischemia or hypoxia increase, what brain eeg wave changes occur?

Answer 14

beta waves begin to disappear, and low-amplitude delta waves appear. (delta wave usually high amplitude). This progresses to electrical activity impression with occasional bursts of activity.

Question 15

Wave changes with the onset of ischemia or hypoxia?

Answer 15

Transient increase in beta waves with the eventual development of increased amplitude theta and delta waves.

Question 16

Describe Delta Waves

Answer 16

0-4Hz. High amplitude, Low Frequency. Associated with deep sleep.

Question 17

Describe Theta Waves

Answer 17

4-8Hz. Low amplitude, Low Frequency. Light Sleep.

Question 18

Describe Alpha Waves

Answer 18

8-13Hz. High Amplitude, Moderate Frequency. Inattentive brain, drowsiness - eyes closed

Question 19

Describe Beta Waves

Answer 19

> 13Hz: Moderate Amplitude, High Frequency. Mental activity, Alertness, Normal Awake

Question 20

Describe Gamma Waves

Answer 20

> 40Hz: Low amplitude, High Frequency. High-level processing.

Question 21

Describe the Anesthetic Management when measuring SSEPs

Answer 21

0.5% or less MAC for inhaled, narcotic-based, or TIVA
Nitrous oxide potentiates the depressant effects of inhalation agents
No ketamine or etomidate → can cause changes in amplitude and latency
Paralytic agents do NOT affect SSEP monitoring and can improve readings by minimizing skeletal muscle interference.

Question 22

What are the BIS values and relation to anesthetic depth

Answer 22

0 = flat EEG
<40 = deep hypnotic state
40-60 = adequate anesthesia
100 = fully awake - following commands