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Hard Core Physiology > Neurosurgery > Flashcards

Neurosurgery Flashcards

1
Q

Cushing Response of ICP

A

Hypertension
Bradycardia
Kussmaul Respirations

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2
Q

Cerebral Edema from BBB disruption

A

Vasogenic Edema

  • most common
  • exacerbated in setting of HTN

*tumors, infarct, trauma

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3
Q

Cerebral Edema from cytotoxic edema

A

Metabolic Causes

  • hypoxia, ischemia
  • neurons actively extrude Na+
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4
Q

Corticosteroids in edema?

A

Vasogenic edema from tumors responds well to steroids –> upregulation of tight junctions of BBB

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5
Q

Steroids outside tumors for edema?

A

worse outcomes

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6
Q

Mannitol in aneurysm cases?

A

don’t use, it could reduce CSF and cause hematoma or increased transmural pressure and aneurysmal rupture

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7
Q

Posterior Fossa Surgery considerations

A
  1. Obstructive Hydrocephalus
  2. Brain Stem Injury
  3. Positioning
  4. Pneumocephalus
  5. VAE
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8
Q

Monitoring for brain stem injury?

A

auditory evoked potentials

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9
Q

Venous Air Embolism

A

occurs when pressure w/i open vein is subatmospheric (usually when incision is above heart)
- entrainment of air can travel to heart and cause CV collpase

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10
Q

When is VAE significant

A

depends on rate and amount of air entrainment, presence of R->L shunt
*most air is absorbed by lungs, but large air can cause problems

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11
Q

Pathophys of significan VAE

A

air lock in RV or pulmonary circulation leads to decreased R-side CO and subsequent L-side CO

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12
Q

Signs of VAE

A
  1. drop in EtCO2
  2. increase PaCO2
  3. hypotension
  4. tachycardia
  5. stroke
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13
Q

Monitors of VAE

A
  1. TEE - best
  2. Precordial doppler
  3. EKG
  4. Capnography
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14
Q

Treatment of VAE

A
  1. Notify surgeons -> flood field (ID entry site)
  2. FiO2 100%
  3. Head down (if possible)
  4. Vasopressors + fluid
  5. Aspirate CVC
  6. Bilateral jugular compression
  7. +/- PEEP
  8. ACLS
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15
Q

Goals in head trauma

A

Avoid hypoxia, hypercapnia and hypotension at all costs

  • ICP concerns
  • maintain cerebral perfusion
  • NO STEROIDS*
  • NO ALBUMIN*
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16
Q

Neurogenic pulmonary edema

A

massive sympathetic discharge from increased ICP –> Severe pulmonary vascular congestion and alveolar hemorrhage

17
Q

Ruptured Cerebral Aneurysm timeline

A

sudden, severe WHOL

  • rebleed w/i 24-48 hrs
  • vasospasm w/i 72 hrs - 5 days
18
Q

Vasospasm treatment

A

Nimodipine ppx

  • hydrate, ensure blood pressure
  • intraarterial vasospastic agents
19
Q

What to do if aneursym ruptures in OR?

A
  • adenosine or propofol bolus
  • cooling the patient
  • resuscitating the patient
20
Q

Acute Spinal Cord Injury

A

can cause sympathectomy with unopposed parasympathetic activity leading to drastically hemodynamic derangements during stimulating parts (laryngoscopy, suction, extubation)

21
Q

how long post-stroke should you wait for surgery?

A

Atleast 2 weeks –> altered blood flow and metabolic rate

- altered responsiveness to CO2 and BBB

22
Q

fluid disorders s/p neurosurgery

A

SIADH
Cerebral Salt Wasting
Diabetes Insipidus

23
Q

SIADH exam

A

hyponatremic
euvolemic
lots of urine sodium

24
Q

CSW exam

A

hyponatremic
hypovolemic
high urine sodium

25
Q

DI exam

A

hypernatremic
hypovolemic
Dilute urine - LOTS of urine

26
Q

Common anesthetic drugs that lower seizure threshold?

A

ketamine, methohexital, atra and cisatracurium

27
Q

Hematologic effect of antiepileptics?

A

MOST AED alter coagulation factors….watch for bleeding

28
Q

Parkinson Disease

A

progressive loss of DA neurons in nigrostriatum

increase in GABA in basal ganglia –> inhibits thalamic nuclei and blocks the motor cortex

29
Q

Parkinson symptoms

A

bradykinesia, rigidity, postural hypotension, sensitivity to anesthetics

30
Q

Anesthetic concerns w/ Parkinson

A

continue med pre and intraop!

- avoid anti-dopamine meds –> worsen rigidity (droperidol and metocloperamide)

31
Q

Multiple Sclerosis

A

reversible demyelination of brain and SC (random)

32
Q

Anesthetic concerns w/ MS

A
  • avoid elective surgery during flare
  • stress of surgery can flare
  • peripheral nerve blocks ok, neuraxial less so
  • avoid sux
  • maintain good room temp
33
Q

Amyotropic Lateral Sclerosis

A

disease of upper and lower motor neurons

super-oxide dismutase 1

34
Q

ALS anesthetic concerns

A

affects all muscles!!!

  • respiratory and swallowing
  • avoid sux
  • no neuraxial
35
Q

Guillan Barre

A

sudden ascending motor paralysis and areflexia w/ variable paresthesias
- immune disease of myelin sheath

36
Q

Levels of acute spinal cord injury and complications

A 
T1 = quadriplegia
L4 = paraplegia

Hard Core Physiology (7 decks)

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