Neuro Yoa

Question 1

1. What is the pathology of intracranial tumors?

Question 2

What is intracranial pressure (ICP), and what are its
determinants?

Question 3

How does the presence of a mass alter the ICP in this patient,
and what are the clinical manifestations of these alterations?

Question 4

What is cerebral blood flow (CBF), and what are its
determinants?

Question 5

What are the cerebral steal syndromes?

Question 6

. Are there any issues specific to posterior cranial fossa
pathology?

Question 7

What is the role of preoperative embolization therapy?

Question 8

What are the special considerations in preoperative evaluation
of the patient scheduled for posterior fossa craniotomy?

Question 9

In a patient who presents with intracranial hypertension, what
management might have already been initiated preoperatively,
and what are the implications for anesthetic management?

Question 10

What are the types of intraoperative neurophysiologic
monitoring (IOM) that would likely be used for this procedure,
and how will they affect the anesthetic management plan?

Question 11

What are the options for patient positioning during posterior
fossa surgery?

Question 12

What are the principal disadvantages associated with the
common posterior fossa craniotomy positions?

Answer 12

How does the sitting position affect your preoperative
assessment and planning?

Question 13

What are the anesthetic goals for craniotomy?

Question 14

What monitors should be used during craniotomy?

Question 15

Would you monitor for venous air embolism (VAE)? What are
the monitoring options?

Question 16

Would you monitor for venous air embolism (VAE)? What are
the monitoring options?

Question 17

What specific risks are associated with induction of
anesthesia?

Question 18

How would you induce anesthesia?

Question 19

What are the effects of anesthetics on cerebral metabolic rate
of oxygen (CMRO2), CBF, and ICP? With this in mind, how
would you maintain anesthesia?

Question 20

How would you manage ventilation and maintain arterial
carbon dioxide (CO2)?

Question 21

How would you approach diuretic therapy?

Question 22

How would you manage serum glucose?

Question 23

How would you approach fluid management?

Question 24

Once the bone plate is removed and the dura
retracted, the surgeon reports that the brain is still
“tight.” What would be your response?

Question 25

If deliberate hypotension is indicated, how will you achieve it?

Question 26

While the surgeon is resecting tumor from near the brainstem, the patient’s heart rate suddenly drops to 20 beats per minute. What is your assessment and management?

Question 27

Are there any measures you can take to prevent VAE?

Question 28

During the procedure, the precordial Doppler becomes loud and turbulent. The end-tidal CO2 (EtCO2) drops from 31 to 13 mmHg, and the systemic pressure from 121/63 to 64/32 mmHg. What is your assessment and management plan?

Question 29

What is your approach to emergence? What if the patient does not regain consciousness?

Question 30

What postoperative complications are of greatest concern? What level of monitoring is required?

Question 31

What is your approach to postoperative pain control?

Question 32

In the ICU, the patient’s neurologic status deteriorates and ICP monitoring is instituted. What are the different methods of monitoring ICP, and what are their limitations?