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FRCA Final > Neuroanaesthesia > Flashcards

Neuroanaesthesia Flashcards

1
Q

Incidence of neurological damage during scoliosis correction

A

0.5%

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2
Q

SSEP stimulation electrodes placement

A

Pair of stimulating electrodes placed bilaterally: 1) Posterior Tibial Nerves (Lumbar surgery) 2) Median Nerves (Cervical surgery)

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3
Q

Frequency of SSEP stimulation

A

30mA at 5Hz

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4
Q

SSEP recording electrode placement

A

Proximal to site of surgery: 1) 2 or more scalp electrodes (frontal and cervical) 2) Reference electrode 3) ground electrode

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5
Q

Band filter width for SSEP

A

20-1000 Hz

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6
Q

Shape of characteristic response in SSEP

A

W

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7
Q

Changes seen in SSEP with spinal cord compromise

A

Increased latency Decreased amplitude

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8
Q

Critical change in SSEP

A

50% increase in latency

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9
Q

What is an MEP?

A

Motor Evoked Potential

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10
Q

What is a SSEP?

A

Somatosensory Evoked Potential

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11
Q

What does MEP monitor?

A

Territory of the anterior spinal cord artery (corticospinal tracts)

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12
Q

What does SSEP monitor?

A

Dorsal column integrity

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13
Q

Source of stimulation for MEP

A

Transcranial electrical stimulation Transcranial magnetic stimulation Direct rostral spine stimulation

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14
Q

Risk of transcranial electrical stimulation

A

Injury secondary to mandibular contraction

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15
Q

How are MEPs recorded?

A

S/C / IM needle electrodes in arm and leg muscles

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16
Q

Time taken for MEP response

A

Less than 1 minute

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17
Q

Define Serious Traumatic Brain Injury

A

GCS less than 9 post resuscitation

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18
Q

List some primary prevention strategies for STBI

A

Helmets, airbags, reducing alcohol consumption, speed limits

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19
Q

Define secondary brain injury

A

A hypoxic insult to the brain from oedema, haematoma or low systemic pressure following a primary insult

20
Q

Indications for CT head within 1 hour of TBI

A

GCS less than 13 at any time GCS 13-14 2 hours post injury Open fracture Skull base fracture More than 1 episode of vomitting Seizure Coagulopathy Event amnesia Focal deficit

21
Q

Oxygen targets in TBI

A

PaO2 great than 13

22
Q

CO2 targets in TBI

A

ETCO2 4.5-5

23
Q

MAP target in TBI

A

great than 80

24
Q

Glucose targets in TBI

A

6 - 10

25
Q

Describe the features of diabetes insipidus

A

Raised sodium Polyuria Low urine osmolality

26
Q

CPP target in neuroprotection

A

greater than 60

27
Q

ICP target in neuroprotection

A

Less than 20

28
Q

Rescue therapies in TBI

A

ABC Approach Ensure good venous drainage Increase sedation Hyperventillate to ETCO2 4-4.5 150 mL 5% NaCl Barbiturate Coma (Burst Suppression)

29
Q

What causes the blown pupil in a decompensating head injury?

A

Falsely localising nerve injury (CNIII)

30
Q

How should you treat seizures in TBI?

A

Thiopental or Benzodiazepine immediately. Phenytoin loading immediately afterwards

31
Q

The role of steroids in TBI

A

Generally none

32
Q

Why early fixation in unstable spinal injury?

A

allows for proper nursing care, PT, cough etc.

33
Q

Classical timing for early complications of SAH

A

Hydrocephalus - Day 1 Rebleed - Day 1-7 Ischaemia - More than day 7

34
Q

SAH risk factors

A

Smoking HTN Alcohol Polycystic kidney Family history Female gender Age 40-50

35
Q

SAH incidence

A

6/100,000 patient years

36
Q

SAH outcomes

A

10% die before hospital 40% die within 1 month

37
Q

Fisher Scoring System

A

CT

38
Q

Hunt and Hess Scoring System

A

Arrival clinical

39
Q

WFNS Scoring System

A

GCS and motor

40
Q

What are the hallmarks of a cholinergic crisis?

A
  • Flaccid paralysis
  • Respiratory failure
  • Salivation
  • Excess bronchial secretions
  • Miosis
  • Sweating (sweat glands are the exception to the rule of SNS innervation)
41
Q

What are the indications for urgent (within 1 hour) CT head?

A
  • GCS < 13 when first assessed in emergency department
  • GCS < 15 when assessed in emergency department 2 hours after the injury
  • Suspected open or depressed skull fracture
  • Sign of fracture at skull base haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from ears or nose,
  • Battle’s sign
  • Post-traumatic seizure
  • Focal neurological deficit
  • > 1 episode of vomiting
42
Q

Cerebral ischaemia monitoring in CEA

A
  • Awake
  • Transcranial doppler
  • Stump pressure
  • EEG
  • SSEP
  • NIRS
43
Q

What are the diagnostic criteria for SIADH?

A
  • hypotonic hyponatraemia
    • serum sodium < 135 mmol/l
    • serum osmolality < 280 mOsm/kg
  • urine osmolality > serum osmolality
  • urine sodium concentration > 18 mmol/l
  • normal thyroid, adrenal, and renal function
  • clinical euvolaemia—absence of peripheral oedema or dehydration.
44
Q

How do you treat SIADH

A
  • Conservatively
  • Fluid restrict (1000mL/day)
  • Consider Hypertonic saline (1.8%), but stop at around Na 120 mmol/L
  • Consider diuretics
  • Consider demeclocycline/lithium to inhibit renal response to lithium
  • Consider lixivaptan
45
Q

Cerebral Salt Wasting Syndrome biochemical diagnostic criteria

A
  • low or normal serum sodium;
  • high or normal serum osmolality;
  • high or normal urine osmolality;
  • increased haematocrit, urea, bicarbonate, and albumin as a consequence of hypovolaemia.

FRCA Final (21 decks)

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