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Fall'20 Advanced Principles II > Neuroanatomy (exam 1) > Flashcards

Neuroanatomy (exam 1) Flashcards

1
Q

The brain receives what % of cardiac output?

A

15%

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2
Q

The brain receives how many ml of blood per 100 g of brain tissue per min?

A

50-65 mL

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3
Q

Does hypothermia increase or decrease CBF?

A

Decreases CBF

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4
Q

Does hyperthermia increase or decrease CBF?

A

Increases CBF

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5
Q

Does CBF increase or decrease with age?

A

Decreases with old age

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6
Q

What is the most powerful factor to increase CBF?

A

CO2

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7
Q

True or False: A doubling of CO2 doubles CBF?

A

True

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8
Q

HTN causes a right or left shift of the autoregulation curve?

A

Rightward shift

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9
Q

Metabolically what occurs so that CO2 can cause an increase in CBF?

A

CO2 combines with water to form carbonic acid which forms Hydrogen.
The H-‘s are what cause vasodilation of cerebral vessels (causing an increase in CBF)

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10
Q

The Brain uses O2 at a near constant rate, if CBF becomes insufficient to supply the needed amount of O2 what happens?

A

vasodilation occurs and CBF increases (known as autoregulation)

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11
Q

Both CO2 and O2 can cause an increase in CBF but which one is the most powerful factor?

A

CO2 is the most powerful factor.

O2 as hypoxia is a potent stimulus.

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12
Q

The cerebral blood flow is maintained fairly stable for a MABP of ?

A

50-150 (60-160)

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13
Q

autoregulation shifts to the left with what perfusion problems?

A

hypoperfusion / cerebral ischemia

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14
Q

autoregulation shift s to the right with what problem?

A

chronic HTN

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15
Q

*Arteries that form the circle of Willis?

A

2 carotid and 2 vertebral arteries - which merge to form the Circle of Willis at base of brain.

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16
Q

Three major components of the Intracranial contents?

A

Brain
CSF
Blood

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17
Q

What are astrocytes and their function?

A

star-shaped non-neuronal cells that support and protect neurons as well as provide nutrition.

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18
Q

Electrical stimulation of excitatory glutaminergic neurons leads to?

A

increase in intracellular calcium ion and vasodilation of nearby arterioles.

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19
Q

Does arterial or venous BP fluctuate greatly?

A

arterial

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20
Q

People with hypoperfusion/ cerebral ischemia, autoregulation is shifted to the left or right?

A

left

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21
Q

Autoregulation by 2 separate mechanisms, what are the two mechanisms?

A

Responses to mean blood pressure changes

Responses to pulsatile pressure (perfusion pressure– for example…decreased during CPB)

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22
Q

When MAP rises acutely during strenuous exercise what happens so that vascular hemorrhage does not occur?

A

SNS constricts the large and intermediate-sized brain arteries enough to prevent the high pressure from reaching the smaller brain blood vessels. Thus, preventing vascular hemorrhages.

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23
Q

Give me an example of global ischemia and focal ischemia?

A 
Global = cardiac arrest
Focal = localized stroke
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24
Q

What is Penumbra?

A

an area of moderate ischemia peripheral to an area of greater ischemia, the penumbra area has compromised blood flow.

(immediate revascularization can save neurons in the penumbra)

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25
Q

most sensitive area of the brain for hypoxia/ischemia?

A

hippocampus (area for recent memories)

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26
Q

What is tPA used for?
window of use?
contraindications?
risk/side effects?

A

clot buster, reperfusion of an ischemic area of the brain.

3 hour window of use.

contraindications: hemorrhagic stroke, recent surgery.

Risks/side effects: cerebral hemorrhage

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27
Q

target glucose for treatment of cerebral ischemia?

A

target 180 mg/dl

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28
Q

Treatments for epilepsy?

A

Benzodiazepine

Barbiturates

Anti-epileptic (phenytoin)

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29
Q

What are most strokes caused by?

A

arteriosclerotic plaques that occur in one or more of the feeder arteries to the brain.

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30
Q

Most common arteries affected by Hemorrhagic strokes?

A

Middle Cerebral Artery

Posterior Cerebral Artery

Midbrain arteries

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31
Q

Entire capacity of cerebral cavity enclosing brain and spinal cord is about how much in mL?

A

1600-1700mL

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32
Q

CSF alone is how many mL?

A

150mL

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33
Q

Rate of CSF formation is about how much per day?

A

500-600mL/day

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34
Q

What is Coup, Contrecoup, and coup contrecoup?

A

Coup = contusion on the same side as the impact injury.

Contrecoup = injury to the opposite side as the site of injury.

Coup contrecoup = injury at the site of trauma and the opposite side of the brain.

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35
Q

What structure is responsible for drainage or reabsorption of CSF?

A

Arachnoid Villi

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36
Q

Normal CSF pressure in children is?

Adults?

A 
children = 3-7.5
adult = 4.5-13.5

Just need to know that children is less than adults.

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37
Q

What is normal ICP?

A

less than or equal to 20

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38
Q

What is the main cause of death after head injury?

A

Elevated ICP

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39
Q

Intracranial pressure curve, what does point 3 and 4 tell you?

A

At point 3, focal ischemia occurs.

At point 4, global ischemia occur

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40
Q

Sustained elevation of ICP leads to?

A

brain herniation

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41
Q

Normally increases in volume (ICP) are initially well compensated, what points on the Intracranial pressure curve would this be?

A

1 and 2

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42
Q

*What is Cushings Triad?

A

increase ICP leads to reflex increase in MAP (hypertension), decrease in HR (bradycardia) and irregular respiration.

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43
Q

Intracranial Hypertension would be defined as?

A

ICP greater than 20 mmHg

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44
Q

What are some causes of intracranial hypertension?

A

mass lesion
hematoma
head trauma

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45
Q

herniation of the brain due to increased ICP will occur through what two structures?

A

tentorial notch

foramen magnum

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46
Q

Intracranial hypertension will cause what to occur on the same side of the mass?

A

cranial nerve three compression on the ipsilateral side = fixed dilated pupil to the same side as the mass (also cushings triad)

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47
Q

Chronic intracranial hypertension will cause?

A

papilledema

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48
Q

Treatment of intracrainial hypertension?

A

ABCs

Intubation plus hyperventilation

Maintain PCO2 level 25-30ish mmHg

Mannitol

Sedation

Steroids

Slowly wean from ventilator

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49
Q

Glasgow coma score, tell me what each number range means?

A

Glasgow coma score < 7

Severe brain injury defined as < 8-9

Moderate injury = 8-12

Minor injury = > 13

can’t ever have a ZERO

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50
Q

Two techniques to monitor ICP today? (explain)

A

1…intraventricular (requires cannulation of ventricular frontal horn)

2…intraparenchymal (often held in place by bolt screw)

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51
Q

An increase in ICP can reduce what?

A

CBF

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52
Q

Cerebral blood flow and BP is maintained pretty constant over a wide MABP, what would that range be?

A

50-150

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53
Q

What does CPP measure?

A

Cerebral Perfusion Pressure (CPP)- Is actually what is measured as a surrogate for Cerebral Blood flow under conditions where stats are rapidly changing (i.e. ill person with increased ICP and possible herniation in progress)….

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54
Q

What measurement is the difference between MAP and the greater of ICP or CVP?

A

CPP

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55
Q

equation for CPP is?

A

MABP - ICP or CVP (whichever is greater)

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56
Q

What should the CPP range be, and what do the ranges mean?

A

CPP Goal- Maintain above 50-55

CPP < 40 considered critical

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57
Q

Difference between communication and non-communicating Hydrocephalus?

A

Communicating: Caused by blockage of fluid flow around base of brain or by blockage of arachnoidal villi
Fluid collects on the outside of brain and some collects inside the ventricles

Non-Communicating:Caused by block in aqueduct of Sylvius
Volumes of lateral and 3rd ventricle increase greatly

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58
Q

BBB is permeable to?

A

Water
CO2
O2
Most lipid-soluble substances

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59
Q

BBB is slightly permeable to?

A

Electrolytes: Na+, Cl, K+

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60
Q

BBB is impermeable to?

A

Plasma proteins

Non-lipid-soluble large molecules

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61
Q

What can cause the BBB to be more permeable? (like a break in the barrier)

A 
Microwaves
Radiation
Trauma
Hypertension
Infection
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62
Q

What typically causes Brain Edema?

A

Usual cause is increased capillary pressure or damage to capillary wall that makes the wall leaky to fluid.

Starts a vicious cycle: edema decreases blood flow, causing ischemia, then more edema

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63
Q

Most of the Brains energy is supplied as what? and how long will that supply last?

A

Glucose

only a 2 minute supply of glucose stored as glycogen in the neurons.

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64
Q

Most common first degree brain tumor is?

A

Astrocytoma

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65
Q

Do first degree brain tumors commonly or rarely undergo metastasis?

A

rarely

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66
Q

What type of prognosis and expectancy does astrocytoma have?

A

grave prognosis and less than 1 year life expectancy.

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67
Q

2nd most common first degree brain tumor? (arise from arachnoid cells external to the brain, slow growing)

A

Meningioma

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68
Q

Tumor found in the 4th ventricle, can cause hydrocephalus, poor prognosis?

A

Ependymoma

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69
Q

tumor that is relatively rare and slow growing?

A

oligondendroglioma

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70
Q

Most common prolactinoma, causes tunnel vision, hyper or hypo pitutarism can result?

A

Pituitary adenoma

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71
Q

3rd most common first degree tumor with schwann cell origin?

A

Schwannoma

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72
Q

What nerve is an acoustic schwannoma tumor localized to?

A

VIII nerve

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73
Q

What test is diagnostic for seizures?

A

EEG

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74
Q

What type of seizure does not cause a loss of consciousness?

A

Focal (partial) seizure arise from discrete region, no loss of consciousness

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75
Q

causes of tumors in children, adults, and elderly?

A

Children- genetic, infection (febrile), trauma, congenital, metabolic

Adults- tumors, trauma, stroke, infection

Elderly- stroke, tumor, trauma, metabolic, infection

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76
Q

What is the major goal in neurosurgical anesthesia?

A

to provide adequate tissue perfusion to brain and spinal cord so that regional metabolic demand is met and to provide adequate surgical conditions (“a relaxed brain”)

77
Q

In general IV anesthetics do what to CMR and CBF

where most inhalation anesthetics cause what change to CMR and CBF?

A

IV anesthetics decrease cerebral metabolic rate (CMR) and CBF in parallel fashion….

Most inhalational anesthetics decrease CMR with an increase in CBF (cerebral vasodilation)

78
Q

What CANNOT not be recommended in patients who have experienced stroke?

A

hyperventilation

79
Q

Hypercapnia is what?

A

high CO2

80
Q

what is hypocapnia?

A

low CO2

81
Q

what CO2 concentration can dilate vessels in the normal area of the brain but not in the damaged (ischemic) area?

A

high or hypercapnic

82
Q

what is intracerebral steal?

A

“stealing from the poor”

Hypercapnia -

when blood flow is shunted away from an ischemic area to a normal blood flow area of the brain.

83
Q

what CO2 concentration can divert blood flow from the normal area of the brain to an ischemic area?

A

low or hypocapnic

84
Q

what is “reverse” cerebral steal/Robin hood effect?

A

“stealing from the rich to give to the poor”

when blood is diverted from a normal area of the brain to an ischemic area.

Hypocapnia (low CO2)

85
Q

How can you induce the “steal” phenomena?

A

pharmacologically with anesthesia (not hyperventilation)

86
Q

Anesthesia alters ICP through changes in what?

A

CBV (which appear to be proportional to changes in CBF, thus in ICP)

87
Q

Intracerebral steal VS. reverse steal?

A

intracerebral = blood flow away from ischemic area.

reverse = blood flow to ischemic area

88
Q

How are the smaller blood vessels in the brain protected when MAP rises acutely? (ultimately protecting against vascular hemorrhage)

A

SNS constricts the large and intermediate-sized brain arteries enough to prevent the high pressure from reaching the smaller brain blood vessels. Thus, preventing vascular hemorrhages.

89
Q

Sensory CN are?

A

I olfactory, II optic, VIII vestibulocholear

90
Q

Motor CN are?

A

III occulomotor, IV trochlear, VI abducen, XI accessory, XII hypoglasal

91
Q

What 4 large arteries merge to form the circle of Willis?

A

2 carotid and 2 vertebral arteries.

92
Q

—— is the basic functional cell of the CNS?

A

Neuron

93
Q

Sensory or Motor neuron has multiple dendritic processes and constitutes the majority of the CNS.

A

Motor

94
Q

What cell lines the roof of the 3rd and 4th ventricles of the brain and central spinal cord. They also form the choroid plexus which secretes CSF?

A

Ependymal cells

95
Q

These cells develop into large macrophages that phagocytize neuronal debris?

A

Microglia cells

96
Q

Forms the myelin sheath of axons in the brain and spinal cord and are capable of mylenating more than one axon?

A

Oligodendrocyte cells

97
Q

This cell forms the myelin sheath of peripheral nerves?

A

Schwann cells

98
Q

electrical stimulation of excitatory glutaminergic neurons leads to increase in ?

A

intracellular calcium ion and vasodilation of nearby arterioles.

99
Q

Rate of CSF formation is constant, this makes what really important?

A

This makes drainage or reabsorption by arachnoid villi important!

100
Q

blockage of CSF drainage or reabsorption by the arachnoid villi can be caused by?

A

tumor
hemorrhage
infection

101
Q

what are the three signs of cushing’s triad?

A
  1. Irregular respiration
  2. Bradycardia
  3. hypertension
102
Q

VAE is most often associated with what procedure?

A

posterior fossa procedures in the sitting position.

103
Q

Intraoperative goals if a patient is suspected to have or does have a venous air embolism?

A
  1. inform the surgeon immediately.
  2. discontinue nitrous, increase 02 flows.
  3. modify the anesthetic.
  4. Have the surgeon fluid the surgical field.
  5. provide jugular vein compression
  6. aspirate the right atrial catheter.
  7. provide cardiovascular support.
  8. change the patients position.
104
Q

most sensitive / noninvasive for VAE?

A

TEE

105
Q

*Onset of insult when monitoring with evoked potentials would look like what?

A

decrease in amplitude and

increases in latency

106
Q

When an evoked potential changes what must you do?

A

you must assess the physiologic, anesthetic, and surgical environment to determine what has contributed to the change.

107
Q

*What does diffuse ischemia look like when monitoring evoked potentials?
What does mechanical injury or localized ischemia look like?

A

slow loss of response amplitude with an increase in latency = diffuse ischemia

fast losses of amplitude with minimal latency changes = mechanical injury or localized edema.

108
Q

Medication commonly used for evoked potentials is opioids, why?

A

cause only mild depression of all responses

109
Q

volatile anesthetics and N20 produces what kind of evoked potential changes?

A

decrease in amplitude and increase in latency

110
Q

most commonly monitored evoked potential is?

A

SSEP

111
Q

What evoked potential is used during CEA?

A

Cortical SSEP

112
Q

What medication is acceptable to use with SSEP but not ok to use with MEP?

A

NMB are acceptable with SSEP

113
Q

A change in SSEP corticol amplitude is most sensitive indication of what?

A

ischemia

114
Q

SSEP can be used to monitor ischemia from what all factors?

A 
VASOSPASM
retractor pressure
hypotension
clipping
hyperventilation
115
Q

If SSEP is used during spinal cord surgery what can it identify?

A

mechanical or ischemic insult when they result in alteration or loss of transition through surgical field.

116
Q

What evoked potential is used extensively for monitoring during surgery involving posterior fossa?

A

ABR (auditory brainstem responses)

117
Q

When are visual evoked potentials used?

A

during craniofacial procedures,
pituitary surgery, and surgery in the
retrochiasmatic visual tracts and occiptal cortex.

(considered less useful in surgery)

118
Q

What evoked potential is very common in spinal surgery?

A

MEPs bc it has a very good correlation with post-op outcome.

50-80% reduction in morbidity

119
Q

Preferred form of anesthetic delivery when using MEP?

A

TIVA is preferred

(propofol with or without ketamine in combination with opioids) discuss with surgeon.

120
Q

Name the CN 1-12

A 
1 olfactory
2 optic
3 oculomotor
4 trochlear
5 trigeminal
6 abducens
7 facial
8 auditory
9 glossopharyngeal
10 vagus
11 spinal accessory
12 hypoglossal
121
Q

Most common CN monitored during surgery is?

A

Facial nerve (CN 7)

Orbicularis oculi and/or orbicularis oris muscles

122
Q

stimulation of what two CN will cause CV changes?

A

CN IX and X

123
Q

stimulation of this CN can cause potentially harmful head movement (sternocleidomastoid and trapezius activation)

A

CN XI

124
Q

What CN monitoring is becoming common in skull base and anterior neck procedures?

A

X vagus nerve

125
Q

Best choice muscle relaxant (during induction) for head injury with HTN and disturbed autoregulation?

A

Nondepolarizing neuromuscular relaxants do not appear to have clinically significant direct effects on CBF or CMRO2, provided MAP is not altered after administration

Rocuronium 1 mg/kg

126
Q

How do IV anesthetics change CMR and CBF?

A

IV anesthetics decrease cerebral metabolic rate (CMR) and CBF in parallel fashion

127
Q

How do inhalational anesthetics change CMR and CBF?

A

most inhalationals decrease CMR with an increase in CBF (cerebral vasodilation)

128
Q

How do anesthetic agents change the affect of ICP?

A

by changing the rate of production and reabsorption of CSF/

129
Q

Hyperventilation and head trauma, what is correct and incorrect?

A

Hyperventilation can rapidly control intracranial HTN, but prolonged and extreme hypocapnia (low CO2) from hyperventilation can result in a marked decrease in CBF in pts with head trauma (another reason it is C/I in CVA).

Only short duration of mild to moderate hyperventilation (hypocapnia) should be initiated (other pharmacologic/surgical intervention should be performed to control critical intracranial HTN)

130
Q

“BEST” inhaled anesthetic for NEURO patients would be?

A

Isoflorane

131
Q

cerebral vasodilators (capable of increasing ICP) usually depress metabolism EXCEPT for

A

N20

132
Q

Why does N20 have restricted use in neurosurgical procedures?

A

N/V incidence among other properties

133
Q

When N20 is added to volatile anesthetics it increases both what and what?

A

CBF and CMR

134
Q

What gas has no direct vasodilating effect as well as the most dramatic increase in CBF and ICP when administered alone?

A

N20

135
Q

Other name for Isoflurane?

A

Forane

136
Q

What has Isoflurane been reported to do to whole brain metabolism?

A

reduce whole brain metabolism by half.

potent cerebral metabolic depressive effects.

137
Q

Which gas has the only property to increase ICP mildly but can be prevented with hypocapnia?

A

Isoflurane

138
Q

Which gas has the disadvantage of compound A renal toxicity?

A

Sevoflurane

139
Q

What is the other name for Sevo?

A

Ultane

140
Q

What surgical situation can make sevo undesirable to use?

A

prolonged anesthesia for neurosurgery with preexisting renal disease.

141
Q

Which two gases may have neuro-protective effects similary to Iso? One is proven clinically and one is not…

A

proven clinically = Des

not proven clinically = Sevo

142
Q

Why is ketamine a unique IV anesthetic?

A

increases both CBF and CMR while all other IV anesthetics decrease both.

(synthetic opioids are a possible exception, may slightly increase ICP)

143
Q

what IV anesthetic has the effect to keep ICP the same or slightly increase?

A

synthetic opioids

144
Q

True or False

IV anesthetics decrease CBF and CMR due to vasoconstriction?

A

False, - Decrease in CBF by most is a result of reduced cerebral metabolism secondary to cerebral functional depression… not due to vasoconstriction

145
Q

Does etomidate have CV side effects, does it change CMRO2, and what are it’s adverse effects?

A

does not have CV side effects.

decreases CMRO2 like barbs

Adverse effects: adrenocortical suppression & frequent occurrence of involuntary muscle activity and seizure activity – use with great caution with pt having history of seizures

146
Q

Should propofol be used in children?

A

Prolonged use may cause systemic acidosis and progressive cardiac failure and even death in children…use of prolonged infusion in children is UNJUSTIFIED

147
Q

Propofol has dose related decreases in what and what?

It also decreases what else?

A

dose related decreases in CBF and CMR02.

Also decreases ICP

148
Q

What all does ketamine increase?

A

increases CBF, CMRO2, and ICP.

149
Q

the markedly increase in ICP by ketamine can be blocked or attenuated by what?

A

induced hypocapnia, thiopental, or benzos

150
Q

What does Versed do to ICP?

A

decrease or no change to ICP

151
Q

Which is better at maintaining hemodynamic stability, versed or thipental?

A

Versed

152
Q

Flumazenil and pts with impaired intracranial compliance?

A

Flumazenil (antagonist) also antagonizes effects of benzo of CBF, CMRO2, and ICP – use cautiously when reversing sedation in pts with impaired intracranial compliance

153
Q

What opioid is used in neurosurgery with satisfactory results more so than any other?

A

Remifentanil which is fast on and fast off.

alfentanil can also be used over fentanyl and sufentanil

154
Q

Succinylcholine and use with neuro patients?

A

elevates ICP, may be prevented or decreased with pretreatment with NDMR.

Induced hyperkalemia is another concern with neuro patients and Sch. use

155
Q

cytotoxic brain swelling

A

shift of fluid from extracellular to intracellular space

o Cytotoxic (intracellular) edema- fluid accumulating within cells as a result of injury, usually from toxicity, ischemia or hypoxia

156
Q

vasogenic brain swelling

A

shift of fluid from intravascular to extracellular space

o Vasogenic- brain metastases, abscesses, trauma, hemorrhage (develops as a result of a physical disruption of the vascular endothelium or functional alterations in endothelial tight junctions

157
Q

vasogenic brain swelling is most commonly incolves

A

involves the white matter

158
Q

Interstitial brain swelling

A

shift for CSF into extracellular space

o Interstitial edema- CSF migration into the periventricular white matter, commonly due to conditions that impede CSF circulation, absorption or both

159
Q

when observed in extra axial spaces, the most likely cause of intracranial hemorrhage is

A

trauma

160
Q

name the three types of brain herniation:

A
  1. ) subfalcine
  2. ) transtentorial
  3. tonsillar
161
Q

If presented with a patient with s/s of cushings triad, what type of herniation is most likely the cause?

A

Tonsillar

features inferior displacement of the cerebral tonsils through the foramen magnum into the cervical spinal canal… results in compression of the medulla, producing dysfunction of respiratory and cardiac rhythm centers

162
Q

occurs when a hemispheric mass pushes the cingulate or supracingulate gyri beneath the falx (easily recognized on CT or MRI from deviation of falx and extension of hemispheric structures across midline

A

subfalcine herniation

163
Q

occurs when a mass on either side of the tentorium causes brain herniation through the tentorial incisura (descending or ascending)

A

Transtentorial-

164
Q

features inferior displacement of the cerebral tonsils through the foramen magnum into the cervical spinal canal… results in compression of the medulla, producing dysfunction of respiratory and cardiac rhythm centers

A

tonsillar

165
Q

this type of hydrocephalus results from excessive CSF production by choroid plexus tumors or from obstruction to CSF absorption by arachnoid villi which may be caused by SAH/meningitis

A

communicating

*elevated pressures, CSF may leak from ventricles into brain interstitial edema

166
Q

this type of hydrocephalus results secondary to obstruction along the CSF pathway b/w the lateral ventricles an the fourth ventricular outlet

A

obstructive

167
Q

Preferred imaging modality for initial assessment of TBI

A

CT

168
Q

shows greater sensitivity than CT for detection is subtle lesions & better suited for evaluation of subacute and chronic TBI (unexplained neurologic deficit that cannot be explained by CT)

this technique is also superior to CT in detecting axonal injury, small areas of contusion, and some lesions in brainstem, basal ganglia, and thalami

A

MRI

169
Q

diffuse axonal injuries (DIAs) are

A

shear injuries

related to primary TBI lesions

170
Q

Major contributors to secondary TBI:

A 
	Hypotension
	Hypoxemia
	Hypolycemia
	Hypocarbia / Hypercarbia
	Hyperglycemia
171
Q

SAH-non-contrast CT primary screening tool, however, THIS is gold standard for detection of intracranial aneurysm- also represent tx. modality b/c it permits coiling of aneurysm and endovascular tx. of vasospasm

A

DSA

172
Q

for aan AVM what is the gold standard for imaging evaluation?

A

DSA

173
Q

EMG responses are resistant to effects of ____ except ____.

A

resistant to: anesthesia

except: NMB

174
Q

Common “relative” contraindications for MEPs are:

A

epilepsy, cortex lesion, skull defects, high intracranial pressure, intracranial apparatus (electrodes, vascular clips, shunts), cardiac pacemakers, and implanted pumps

175
Q

during monitoring of EPs Hypothermia can mimic :

latency & amplitude changes:

A

surgical change

-increased latency & decreased amplitude

176
Q

during monitoring of EPs Volatile anesthetics produces what changes to latency & amplitude?

A

increases latency and decrease in amplitude

177
Q

during monitoring of EPs, N2O produces what changes to latency & amplitude?

A

increased latency and decreased amplitude

178
Q

patients who are at risk for an ischemic event should not be infused with what type of solutions?
why?

A

Dextrose solutions
-Hyperglycemia should be avoided in pts at risk for an ischemic event.

Tight glucose control can increase risk of hypoglycemia which could be harmful to pt - discuss with the surgeon

179
Q

during a craniotomy, what solutions are generally avoided?

A

hypo-osmolar and dextrose containing solutions

180
Q

Ideally, IV fluid should be administered at rate to maintain CO but avoid

A

excessive fluid resuscitation

181
Q

during infusion of mannitol, ICP may do what?

A

increase transiently (vasodilation of cerebral vessels in response to sudden increase to increased osmolarity.)

-then may decrease ICP by movement of water from brain interstitial and intracellular spaces into vasculature –> the end result

182
Q

o Production of large volumes of dilute urine and normal or elevated plasma osmolality (severe cases 1 liter/hour) is

A

Diabetes insipidus

183
Q

type of fluid that should be used to rehydrate a pt with DI?

A
  1. 45% NS until euvolemia.

- NS should not be used for initial rehydration b/c of preexisiting hyperosmolar/hypernatremic state

184
Q

in trauma patient with a head injury; what is the Ideal resuscitation with hypovolemia and ongoing blood loss

A

fresh whole blood

185
Q

in a trauma patient or one with a head injury; what fluids are not recommended? why?

A

Hetastarch and dextran not recommended due to coagulopathy

186
Q

first choice volume resuscitation of trauma pts with head injuries is

A

isotonic crystalloid solutions

187
Q

amount of Na, K , Cl, and Ca found in 1L of NS

A 
Na = 154 meq
Cl = 154 meq
188
Q

amount of Na, K , Cl, and Ca found in 1L of LR

A 
Na = 130meq
K = 4 meq
Ca = 3 meq
Cl = 109 meq
189
Q

major disadvantage to NS is the possible development of

A

hyperchloremic acidosis in large volume resuscitation

Fall'20 Advanced Principles II (7 decks)

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