Neuroanesthesia

Question 1

CBF change with PaCO2 change

Answer 1

CBF decreases 2% per PaCO2 drop by 1

Question 2

What is heparin?

Answer 2

It is an anticoagulant that works by binding AT3 thereby enhancing its activity of blocking the common pathway of the coagulation cascade

Question 3

What is ACT

Answer 3

activated clotting time. Exposes blood to tissue factor and counts the number of seconds it takes to clot. Measures the INTRINSIC cascade

Question 4

DDx for hTN after CPB initiation

Answer 4

hemodilution»> cardioplegia > malposition of cannula (are we full flow? reposition, cannulate innominate)

Question 5

“Do you want to give mannitol?”
“What happens if you give it too quickly?”

Answer 5

Mannitol can decrease ICP if the BBB is intact. If this is trauma, then use is controversial.
If given too quickly it can cause CHF and/or hypotension

Question 6

GCS score make-up

Answer 6

4 Eyes, 5 Mouth (Jackson 5), 6 Motors (V6 engine)

Question 7

Why use MEPs if already using SSEPs?

Answer 7

SSEPs monitor the posterior columns directly and anterior indirectly. But have a Hugh false positive rate. MEPs serve to double check in the instance of a false positive SSEP.

Question 8

What are the systemic effects of a growth hormone secreting tumor?

Answer 8

Skeletal and soft tissue overgrowth, large hands, feet, nose, mandible, tongue, tonsils. Insulin resistance. HTN. Atherosclerosis. OA. Muscle weakness. Cardiomyopathy. Vocal cord palsy. OSA. Glotic stenosis