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Principles 1 > Neuro Monitoring > Flashcards

Neuro Monitoring Flashcards

1
Q

detects decreases in perfusion and ultimately ischemia based on reductions in electrical brain activity

A

EEG

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2
Q

CBF average

A

50 mL/100 gm/min but can vary regionally from 30-300 mL/100 gm/min

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3
Q

CBF < 25 mL/100 gm/min =

A

slowing of EEG

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4
Q

CBF ≈ 15-20 mL/100 gm/min =

A

isoelectric EEG (internal cell)

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5
Q

CBF < 10 mL/100 gm/min =

A

↓ cell integrity, irreversible injury

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6
Q

CPP of this will show EEG changes

A

CPP < 50 torr

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7
Q

CPP of this shows ↓ cell integrity, irreversible damage

A

CPP < 25 tor

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8
Q

what does an EEG monitor?

A

electrical signals of the cerebral cortex

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9
Q

Readings of EEG can be misinterpreted with what 4 pathologies?

A

hypothermia,
hypercapnia,
electrolyte imbalance,
volatile anesthetic agents resemble ischemic ∆s

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10
Q

affects brain focally and asymmetrically

A

ischemia

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11
Q

affects brain symmetrically

A

anesthesia

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12
Q

Major rhythm seen in normal
resting relaxed awake adults. stops in eye
opening and mental exertion.

A

alpha 8-12 htz

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13
Q

Fast activity, alert, eyes open,

concentrating, anxious or busy thinking.

A

Beta - 13-40 Hz

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14
Q

Slow activity, considered abnormal
in awake adults. Can indicate encephalopathy,
subcortical lesions, Normal in young children.

A

Theta - 4-7 Hz

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15
Q

slowest frequency and highest
amplitude. Subcortical lesions and
encephalopathy, hydrocephalus. Normal in babies.

A

Delta - 1-3 Hz

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16
Q

Anesthetic effects on EEG Barbiturates and Benzodiazepines

A

accentuate frequency then

decrease it.

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17
Q

Opioids Anesthetic effects on EEG

A

slow frequency, increase amplitude

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18
Q

Inhalation anesthetics effects on EEG

A

both frequency and amplitude are reduced

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19
Q

flat line EEG associated with anesthesia

indicative of decreased metabolic oxygen demands and neuroprotective qualities.

A

Isoelectric state:

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20
Q

conscious recall or

remembering exact events of previous experiences

A

Explicit (conscious) memory

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21
Q

movement and ability
to respond to commands without specific conscious
recall of events (some call awareness w/o recall)

A

Implicit (unconscious) memory

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22
Q

also known as “recall” is defined as a
consciousness(explicit memory) under general
anesthesia with subsequent recall of the experienced
events

A

awareness

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23
Q

paralysis of un-anesthetized patients
occurring when patients are given NMB prior to
anesthesia (out of sequence, mislabeling)

A

Awake paralysis

24
Q

risk factors for awareness

A

< 60 y.o., ASA 1-2, female, elective surgery

25
Q

3 primary reasons for awareness?

A
  1. light anesthesia
  2. pt requires an increased level of anesthetic
  3. anesthetic delivery problems
26
Q

Signs of “Light” Anesthesia and possible

awareness/recall [none reliable]

A 
• Minor patient movement
• Tearing and sweating
• Autonomic nervous system changes
–Tachycardia
–Hypertension
–Increased respiratory rate and depth if spontaneous 
respiration
27
Q

drugs that Mask physiological responses to light anesthesia

A

–Amphetamines
–Beta blockers
–Calcium channel blockers
-NMB

28
Q

what vitamin interferes with anesthesia levels?

A

vit C

29
Q

Reducing the Risks of Awareness Claims

A
  • premedicate with amnestic drugs - benzo, scopalamine

- MAC >.7 monitoring expired

30
Q

Quantitative EEG index assessing level of

consciousness during sedation or anesthesia

A

Patient State Analyzer Array PSArray

31
Q

what regions of brain does PSArray monitor?

A

Analyzes anterior and posterior and bilateral

regions of the brain

32
Q

Analysis of raw EEG data to derive a formula-driven

numerical value indicative of level of consciousness

A

BIS

33
Q

3 things BIS takes into account?

A

–Amount of slow wave content (beta ratio)
–Amount of bicoherence of all frequency pairs
–Amount of burst suppression present (ratio)

34
Q

General anesthesia is a BIS reading of

A

40-60

35
Q

BIS value of 0 represents

A

flat line EEG

36
Q

BIS value >

70 is associated with

A

increased probability of

recall

37
Q

Arguments against relying on BIS

A 
hypothermia
shivering
unipolar cautery
ketamine and N2O
head trauma 
patient position
38
Q

Electrical signals produced in response to

various stimuli by the nervous system to monitor neuronal pathway

A

Evoked Potentials

39
Q

4 types of evoked potentials

A

somatosensory (SSEP), motor

MEP), auditory (BAEP), and visual (VEP

40
Q

how t general anesthetics affect Evoked Potential Monitoring

A

inhibit neurotransmission of impulses

41
Q

produce a dose-dependent increase

in SSEP latency and decrease in amplitude

A

volatiles

42
Q

IV anesthetics affect SSEP ___ inhaled anesthetics

A

less than

43
Q

meds that increase SSEP amplitude

A

Etomidate and Ketamine

44
Q

have little to no affect on SSEP amplitude

A

opioids

45
Q

nitrous affect on SSEP amplitude?

A

60% decreased SSEP, but had no effect on latency

46
Q

decrease SSEP

A

reduction in blood flow

47
Q

Assesses corticospinal tracts that are not monitored by SSEP

A

Motor Evoked Potentials (MEP)

48
Q

Monitors motor response to nerve stimulation.

A

EMG

49
Q

Damage to the sensory pathway will display a

A

decreased

signal amplitude and an increased latency

50
Q

optimal MAC?

A

0.5-0.7 MAC

51
Q

valuable indicators of depth of anesthesia.

A

The rate, rhythm, and muscles used for respiration

52
Q

explain ether eye signs

A

The gaze becomes disconjugate during stage II and becomes congruent again when stage III is entered.

53
Q

No substantive changes in respiration, heart
rate, pupillary activity, reflexes or muscle
tone.

A

Stage I: Analgesia and Disorientation

54
Q

Respiration: irregular, breath holding/apnea,
gasping.
Reflexes: hyperactive.
Muscle Tone: hyperactive, often thrashing
extremities.

A

Stage II: Delirium, Agitation, and Excitement

55
Q 
Medullary Paralysis (Moribund)
Progressive cardiovascular collapse
A

stage IV

Principles 1 (12 decks)

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