Systems Review 2 Neuro

Question 1

Normal ICP

Answer 1

< or = 15 mmHg

Question 2

Weight of Brain. oxygen %. Blood output

Answer 2

1400g. 20%. 15%

Question 3

The cerebral perfusion pressure normally (Flat portion of ICP curve)

Answer 3

If CPP is between 50-150mmHg

Question 4

If CPP below 50 then…

If CPP above 150mmHg

Answer 4

CBF falls in MAP, Vasodilation is maximal

Vasocon is max, and interstitial leak

Question 5

Raised ICP results (3)

Answer 5

Brain herniation, cerebral ischemia since reduced CPP, brain shifts

Question 6

What do we drugs avoid BEFORE neurosurgery? What about right before you control airway for emergency craniotomy?

Answer 6

opioids and sedatives since increase ICP since decreased DD leading to ICP elevation. fentanyl 5-10 mcg /kg

Question 7

How to lower ICP? (6)

Answer 7

• Elevate head
• hyperventilate (PaCO2 25-30 mmHg)
• drain CSF
• Osmotic diuretics
• steroids
• propofol/barbituates

Question 8

Primary pathology concerns increasing ICP

Answer 8

vascular lesions, tumors

Question 9

What vascular access do we need for neuro?

Answer 9

arterial catheter ( A line) for frequent lab draws, a second IV. Get your urinary catheter too!

Question 10

Worst agent for neuro bc CPB increased? Best agents for neuro?

Answer 10

Ketamine! best: propofol des sevo fent remi.

Question 11

Volatile agents will increase or decrease cerebral blood flow

Answer 11

increase bc vasodilation

Question 12

Will you generally hyperventilate them? What should CO2 be under

Answer 12

Yes (until RSI.) under 30

Question 13

What does Nitrouse oxide do for neuro? do we use it

Answer 13

Dont use it . increased oxy metabolism and increased ICP?

Question 14

Does SUX increase or decrease ICP? clinically relevant?

Answer 14

increase. not really…

Question 15

Typical crainial tumor patient? Matt Chickey.

Answer 15

s/s increasing ICP, 40-60 yo, adult onset seizure disorder, diagnosed by CT or MRI

Question 16

Drug to you manage fluid and electolyte for neurosurgery? dose? hyper or hypotension

Answer 16

• mannitol = cerebral dehydration and decreased ICP
• 0.25-2 g/kg bolus over 10 mins( 30 min before open the dura)
• hypotension

Question 17

Three pin holder how to keep them still?

Answer 17

patient CANNOT move. so good dose of fentanyl or sevo lots. or propofol.

Question 18

30-60 % of strokes

Answer 18

Intracerebral

Question 19

Subarachnoid hemorrhage description and more adult or peds

Answer 19

hemorrhage between archnoid and pia. mostly in adult than peds

Question 20

Intracranial aneurysm

Answer 20

Intracranial aneurysm, also known as brain aneurysm, is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel.

Question 21

What does PEEP do to ICP?

Answer 21

> ICP blood backs up into brain

Question 22

BEWARE: what can N2o cause for craniotomy?

Answer 22

tension pneumocephalus = nitrous in the air filled space and no good man

Question 23

Emergence techniques to prevent intraoptive hemorrhage

Answer 23

1. do not reverse until head dression on
2. 1.5 mg/kg lido 90 before extub
3. labetalol or Esmolol or NTG