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neurosurgery Flashcards

1
Q

CSF:

  1. what is production in ml/min?
  2. what is production in ml/day?
  3. is volume in child larger or smaller than in an adult?
  4. what 3 meds have a transient decrease in CSF production? (A, F, C)
A
  1. 0.35 ml/min
  2. 500 ml/day
  3. smaller
  4. acetazolamide, furosemide, corticosteroids
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2
Q

ICPs:

  1. full term neonate range mmHg?
  2. children < what mmHg?
  3. increases in what are first sign of increased ICP? (HC)
A
  1. 2-6 mmHg
  2. < 15
  3. head circumference
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3
Q

CBF:

  1. what is normal cerebral blood flow in ml/100g/min?
  2. what % of CO goes to the brain?
  3. there is a linear increase of CBF with arterial CO2 or O2?
  4. PaO2 < what increases CBF exponentially?
  5. PaO2 < what increases CBF 4 fold?
A
  1. 100 ml/100g/min
  2. 25%
  3. CO2
  4. < 50
  5. < 15
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4
Q

cerebral metabolic oxygen rate:

  1. what is it in children? (ml/100g/min)
  2. is CMRO2 higher or lower in children than adults?
  3. in one word describe CBF’s relationship with CMRO2? (L)
A
  1. 5 ml/100g/min
  2. higher
  3. linear
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5
Q

increased ICP signs:

  1. what are 4 classic signs? (P, PD, H, B)
  2. what are 3 chronic ICP signs? (H, I, N)
  3. what time of day are classic signs especially bad?
A
  1. papilledema, pupil dilation, hypertension, bradycardia
  2. HA, irritability, nausea
  3. morning
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6
Q

these are 4 things that increase risk of VP shunt complications:

  1. younger or older age?
  2. prematurity or full term?
  3. increase or decrease number of previous revisions?
  4. longer or shorter time to first revision?
A
  1. younger age
  2. prematurity
  3. increase
  4. shorter
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7
Q

pts with increased ICPs are considered a full stomach and get RSI because they are at risk for what 2 things? (V, PA)

A

vomiting, pulmonary aspiration

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8
Q

VP shunt anesthesia:

  1. avoid what induction med?
  2. premed in these pts can increase what 2 things?
  3. to maintain CPP with induction, prevent an increase in what pressure and prevent what other thing?
  4. what is the most stimulating part of the procedure?
  5. can you give these peds succs?
  6. what physical state do we want for this procedure? (A)
A
  1. ketamine
  2. CO2, ICP
  3. increase ICP, hypotension
  4. tunneling of the catheter
  5. yes
  6. akinesia
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9
Q

what is the most common neuro disorder?

A

epilepsy

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10
Q

antiseizure medications:

  1. they cause an upregulation of what enzymes?
  2. enhanced metabolism of what 2 types of meds?
  3. valproic acid and carbamazepine cause abnormalities in what systems function?
  4. keppra can cause extreme what behavior in peds? (A)
A

1, P450

  1. MRs, opioids
  2. hematologic
  3. agitation
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11
Q

MRI

  1. are eeg leads safe in MRI?
  2. prepare to give what dose range of lorazepam for post-procedure seizures?
  3. do pts with a VP shunt need to have it be reprogrammed after an MRI?
  4. consider what inhaled VA for pts with frequent seizures and recent epilepsy?
A
  1. no
  2. 0.5-1 mg/kg
  3. yes
  4. isoflurane
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12
Q

vagal nerve stimulator:

  1. left or right vagus nerve?
  2. device automatically activated for how many seconds every how many minutes?
  3. are bradycardia and other SEs common with this device?
  4. may be necessary to deactivate it during surgery so it doesn’t interact with what surgery device and to prevent the repeated motion of what?
A
  1. left
  2. 30 seconds q 5 minutes
  3. no
  4. bovee, vocal cords
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13
Q

seizure threshold:

  1. what 2 things lower the seizure threshold? (H, M)
  2. what 3 things raise the seizure threshold? (A, IA, B)
  3. what 3 drugs don’t affect the seizure threshold? (O, N, MR)
A
  1. hyperventilation, methohexital (0.25-0.5 mg/kg)
  2. anticonvulsants, inhaled anesthetics, benzodiazepines
  3. opioids, N2O, muscle relaxants
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14
Q

hemispherectomy:

  1. what is the #1 anesthesia concern with hemispherectomy?
  2. what 3 things need to be discussed with the surgeon? (P, NM, PL)
A
  1. massive blood loss

2. positioning, neuromonitoring, postop location

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15
Q

brain tumors:

  1. early increase in ICP d/t obstructed what?
  2. what are 5 presenting symptoms? (EMV, I, L, CNP, A)
A
  1. CSF flow

2. early morning vomiting, irritability, CN palsies, ataxia

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16
Q

posterior fossa tumor resection:

  1. what is the position for this procedure?
  2. brainstem manipulation can cause acute changes in what and what other c/v thing?
  3. posterior fossa syndrome develops what weird hour range after surgery?
  4. what are the 6 signs of posterior fossa syndrome? (M, SD, D, DMM, CNP, EL)
  5. does posterior fossa syndrome resolve on its own?
A
  1. prone with head flexed
  2. BP, arrhythmias
  3. 24-107 hours
  4. mutism, speech disturbances, dysphagia, decreased motor movement, CN palsies, emotional lability
  5. yes
17
Q

anesthesia for posterior fossa tumor resection:

  1. want to provide an anesthesia that ensures what 2 things? (I, NM)
  2. prepare for what 3 things during maintenance of this procedure? (MBL, V, AHC)
  3. want an immediate what on extubation?
  4. what 2 meds can facilitate a smooth emergence? (HDN, P)
  5. what 2 things do you want to control during induction?
A
  1. immobility, neuromonitoring
  2. massive blood loss, VAE, acute hemodynamic changes
  3. neuro exam
  4. high dose narcotics, precedex
  5. BP, ICP
18
Q

craniopharyngiomas:

  1. what are 3 common things seen in these pts? (GF, VI, EA)
  2. look for signs of what? (H)
  3. what might these pts need to maintain normal hemodynamics?
  4. if not see preop, what is usually seen postop in these pts?
A
  1. growth failure, visual impairment, endocrine abnormalities
  2. hypothyroidism
  3. corticosteroids
  4. diabetes insipidus
19
Q

transphenoidal tumor resection:

  1. treat what adenomas?
  2. is a lot of blood loss seen with this procedure?
  3. should you be prepared for a lot of blood loss?
  4. is ICP a problem with this procedure?
  5. why don’t you want to give these pts mannitol?
  6. monitor UO because what is a possibility?
  7. ensure what level is appropriate and give what if it isn’t?
A
  1. pituitary
  2. no
  3. yes
  4. no
  5. pulls the tumor away from the surgeon
  6. DI
  7. cortisol, hydrocortisone
20
Q

neurofibromatosis:

  1. is type 1 central or peripheral?
  2. is type 2 central or peripheral?
  3. type 1 is associated with other whats? (T)
  4. type 2 is associated with what neurofibromatosis? (BAN)
  5. gliomas of what pathway are seen in these pts?
  6. what are 2 presenting symptoms of these gliomas? (VC, P)
  7. what are 2 late findings of these gliomas? (II, HD)
A
  1. peripheral
  2. central
  3. tumors
  4. bilateral acoustic neurofibromatosis
  5. optic
  6. visual changed, proptosis
  7. increased ICP, hypothalamic dysfunction
21
Q

cerebral hemisphere tumors:

  1. what % of intracranial tumors?
  2. more likely than other tumors to present with what 2 things? (S, FD)
  3. what tumors can cause hydrocephalus by obstructing CSF flow and increasing CSF production? (CP)
A
  1. 25%
  2. seizure, focal deficits
  3. choroid plexus
22
Q

AVMs:

  1. large malformation manifest as what in early infancy?
  2. smaller malformation can be see as what 2 things? (S, S)
  3. AVMs of what 2 vessels manifest as congestive heart failure? (PCA, VOG)
  4. what is the most common presentation of an AVM?
  5. what is the mortality % associted with this presentation?
A
  1. CHF
  2. seizure, stroke
  3. posterior cerebral artery, vein of galen
  4. intracranial hemorrhage
  5. 25%
23
Q

AVM treatment:

  1. what are the 2 options for deep AVMs? (E, R)
  2. what are the 2 options for superficial AVMs? (E, E)
  3. can a pt have a combo of embolization and then resection?
A
  1. embolization or radiation
  2. excision vs emobilzation
  3. yes
24
Q

aneurysms:

  1. children with what 2 conditions have an increased incidence of them? (COTA, PKD)
  2. remain generally what in peds?
  3. if they rupture in childhood, they are generally what?
A
  1. coarctation of the aorta, polycystic kidney disease
  2. silent
  3. fatal
25
Q

aneurysm anesthesia:

  1. control what to prevent aneurysm rupture and surgical site bleeding?
  2. want what 2 parts of anesthesia smooth?
  3. is intraop hypotension advised in small children?
  4. is intraop hypotension advised in peds with increased ICP?
  5. what should you be prepared for?
  6. anesthesia plan should entail a plan for emergent what?
A
  1. blood pressure
  2. induction, emergence
  3. no
  4. no
  5. massive blood loss
  6. craniotomy
26
Q

moyamoya disease:

  1. progressive occlusion of what blood vessels?
  2. primarily in what arteries near the circle of willis?
  3. congenital forms can affect systemic arteries, especially which arteries?
  4. TIAs progress to what and then what?
  5. what therapy is used to medically manage moyamoya?
  6. what is the surgical intervention for this disease? (PS)
A
  1. intracranial
  2. internal carotid arteries
  3. renal
  4. strokes, fixed neuro deficits
  5. antiplatelet
  6. pial synangiosis
27
Q

moyamoya anesthesia:

  1. avoid changes in what?
  2. maintain baseline what?
  3. postop complications are strokes associated with what 2 things? (D, C)
  4. these pts are admitted prior to surgery to ensure adequate what?
  5. what is our main concern in these pts?
  6. why do we want avoid hyperventilation and maintain normocapnia?
A
  1. CBF
  2. blood pressure
  3. dehydration, crying
  4. hydration
  5. strokes
  6. to ensure adequate CBF
28
Q

Neuro IR:

  1. what MAC of gas if neuromonitoring?
  2. what gtt is nice for this case d/t no postop pain?
  3. pt must lay flat for how many hours without leg flexing?
  4. what can be given at end of case to avoid wiggling in PACU and facilitating laying flat?
  5. ensure what isn’t covering the puncture site?
  6. consider extubating deep?
A
  1. half MAC
  2. remi
  3. 6 hours
  4. fentanyl
  5. diaper
  6. deep
29
Q

encephalocele:

  1. failure of what tube to close?
  2. results in the head filled with what?
  3. when are large encephaloceles diagnosed?
  4. small encephaloceles can be seen inside where?
  5. very large encephaloceles lead to difficulty with managing what?
A
  1. neural
  2. CSF
  3. prenatally
  4. nose
  5. airway
30
Q

Meningocele and meningomyelocele:

  1. associated with what allergy?
  2. which one is CSF only?
  3. which one is CSF and neural tissue?
  4. associated with what malformation?
  5. primary closure of meningomyelocele is performed first what of life?
A
  1. latex
  2. meningocele
  3. meningomyelocele
  4. arnold-chiari
  5. days
31
Q

MM and anesthesia:

  1. come to preop in what position?
  2. careful fluid resuscitation to prevent return of what?
  3. pt may have difficulties with what after a tight closure of a large defect? (B)
  4. risk for what related to chiari malformation?
A
  1. prone
  2. fetal circulation
  3. breathing
  4. central apnea
32
Q

TBI phases:

  1. primary injury is the damage that incurred at the time of what? (T)
  2. secondary injury is the damage cause by what 2 processes leading to cerebral edema and elevated ICP? (I, E)
  3. we aim to prevent which type of injury?
A
  1. trauma
  2. inflammatory, excitotoxic
  3. secondary
33
Q

TBI airway:

  1. GCS less than what we intubate?
  2. what cervical level range do young children have greater movement?
  3. what cervical level range after age 12 has maximal movement?
  4. is there a survival advantage to intubating in the field vs bag masking?
  5. what type of laryngoscopy is performed?
  6. why avoid vigorous cricoid pressure in these pts?
A
  1. < 9
  2. C 1-3
  3. C 3-5
  4. no
  5. in-line stabilization
  6. can sublux the injury
34
Q

TBI treatment:

  1. goal is to minimize intracranial what to prevent secondary injury? (H)
  2. EVD controls ICP in what % of pts?
  3. bolus with 3% saline and a continuous gtt at what ml/kg/hr to keep ICP < 20?
  4. if using hypothermia, continue for > how many hours?
  5. rewarming rate should be slower than what degrees per hour?
  6. what is the most commonly used way to decrease ICP?
  7. regional ischemia occurs at what weird % with a PaCO2 of 25-35?
  8. is it possible to lower PaCO2 enough to impair O2 delivery and cerebral hypoxia?
A
  1. hypertension
  2. 87%
  3. 0.1 - 1.0 ml/kg/hr
  4. > 24 hours
  5. 0.5 degrees/hr
  6. hyperventilation
  7. 59.4%
  8. yes
35
Q

TBI and anesthesia agents:

  1. all IV agents cause cerebral vasodilation or vasoconstriction?
  2. all IV agents cause increase or decrease CMRO2?
  3. all inhaled agents cause cerebral vasodilation or vasoconstriction?
  4. all inhaled agents cause increase or decrease CMRO2?
  5. is the IV agents effect coupling or decoupling?
  6. is the inhaled agents effect coupling or decoupling?
A
  1. vasoconstriction
  2. decrease
  3. vasodilation
  4. decrease
  5. coupling
  6. decoupling
36
Q

propofol gtt is not used for sedation in ICUs because of what?

A

propofol infusion syndrome

Peds (9 decks)

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