Neuro- LGH document Flashcards
Craniotomy vs Cranioplasty vs Craniectomy
Craniotomy = surgical opening into the skull
Cranioplasty = surgical procedure to correct a defect in the skull
Craniectomy: removal of part of the skull
T/F: if increased ICP is a concern, you should avoid midazolam
True (sedation can lead to hypoventilation/hypercapnia and lead to swelling of the brain and increased ICP )
What are some things you want to know about your neuro patients?
- Baseline BP
- Baseline neuro status
- MRI- any edema, midline shift, ventricular changes
- Lytes- may have abnormalites due to diuretics
- anticonvulsants
Mannitol concentration and dosing
- 5mg/50mls
0. 25-1mg/kg over 10 minutes
Dosing of furosemide - why might you give this instead of mannitol?
10-20mg
-for patients with cardiac disease who may not tolerate excess volume load
Nitroglycerin - what should you dilute it down to?
40mcg/ml
> 400mcg/1cc –> dilute in 9cc NSS for final concentration of 40mcg/ml
Why might you want to avoid fluids with dextrose in neuro patients?
because it exacerbates ischemia – increases neuronal lactate production > increases edema
What is a concern with NSS and what would you do if it were developing? How would you know?
Hyperchloremic metabolic acodisis
-check ABG and BMP
What part during the case would you want to hyperventilate and why?
immediately post induction > cerebral vasoconstriction, decreases ICP
Where does Dr. D want PaCO2?
28
Where should your MAP be for a craini and why?
> 80 to maintain CPP (MAP-ICP or RAP)
CPP = ….. i forget lol
Why would you give labetolol prior to emergence?
bc there is a signficant correlation b/t emergence hypertension and hemorrage
When should you reverse the crani patient?
After the dressing is on the head
What should you give prior to suctioning for emergence?
Lidocaine 1.5mg/kg 90 seconds prior to suctioning
How much free water is in 1L LR?
100mls
What is a cue that mayfield pins will be going in soon and that you should give a bolus of prop and/or fent like now.
when they ask for a headrest clamp
**HAVE THEM READY TO GO
It pt is in pins, how much roc should you give
10mg/hr (but it also says to check twitches, so what if they have none….)
What can be used as a first line agent if the patient becomes hypertensive?
Propofol!
What should the temp be maintained at?
normothermia to low normal
What does hyperthermia do?
increase swelling and worsen damage
A decrease in temp by ____degrees is neurologically protective
2 degrees
HOB degrees if in pins and why
15-30 degrees
-facilitates venous drainage/CSF drainage
How are the arms positioned for crani?
on armboards at side (get extension)
Order of incision: Skin > _____ > _______
Skin > Bone > Dura
What’s important to know about closing (2 things)
skin/dura closure is painful and may require more anesthetic
- make take up to an hour to close
How much prop should you give for a sudden spike in BP? What else should you do?
50-100mg
deepen gas
When would mannitol be requested if it’s gonna be? and how much?
25g (100mls)
- bring filters
- make sure foley is present
2 cardiac meds not typically used for BP control due to long duration of action and what’s their normal dosing
- Labetalol: 5-10mg bolus
2. Hydralazine: 5-10mg bolus
How is metopropol supplied, what do some dilute it down to and what dose is typically given?
5mg/5ml = 1mg/ml
dilute in 5cc NSS - 0.5mg/ml
push 1-2.5mg/time unless on metoprolol at home (discuss with provider)
If someone is on prednisone, what should you grab form omnicell?
Solumedrol 100mg - may need periop stress dose
What should you be aware of if an inpatient is on decadron?
Dosing regimen and last dose given time
