Systems Review 2 Neuro Flashcards
Normal ICP
< or = 15 mmHg
Weight of Brain. oxygen %. Blood output
1400g. 20%. 15%
The cerebral perfusion pressure normally (Flat portion of ICP curve)
If CPP is between 50-150mmHg
If CPP below 50 then…
If CPP above 150mmHg
CBF falls in MAP, Vasodilation is maximal
Vasocon is max, and interstitial leak
Raised ICP results (3)
Brain herniation, cerebral ischemia since reduced CPP, brain shifts
What do we drugs avoid BEFORE neurosurgery? What about right before you control airway for emergency craniotomy?
opioids and sedatives since increase ICP since decreased DD leading to ICP elevation. fentanyl 5-10 mcg /kg
How to lower ICP? (6)
- Elevate head
- hyperventilate (PaCO2 25-30 mmHg)
- drain CSF
- Osmotic diuretics
- steroids
- propofol/barbituates
Primary pathology concerns increasing ICP
vascular lesions, tumors
What vascular access do we need for neuro?
arterial catheter ( A line) for frequent lab draws, a second IV. Get your urinary catheter too!
Worst agent for neuro bc CPB increased? Best agents for neuro?
Ketamine! best: propofol des sevo fent remi.
Volatile agents will increase or decrease cerebral blood flow
increase bc vasodilation
Will you generally hyperventilate them? What should CO2 be under
Yes (until RSI.) under 30
What does Nitrouse oxide do for neuro? do we use it
Dont use it . increased oxy metabolism and increased ICP?
Does SUX increase or decrease ICP? clinically relevant?
increase. not really…
Typical crainial tumor patient? Matt Chickey.
s/s increasing ICP, 40-60 yo, adult onset seizure disorder, diagnosed by CT or MRI
Drug to you manage fluid and electolyte for neurosurgery? dose? hyper or hypotension
- mannitol = cerebral dehydration and decreased ICP
- 0.25-2 g/kg bolus over 10 mins( 30 min before open the dura)
- hypotension
Three pin holder how to keep them still?
patient CANNOT move. so good dose of fentanyl or sevo lots. or propofol.
30-60 % of strokes
Intracerebral
Subarachnoid hemorrhage description and more adult or peds
hemorrhage between archnoid and pia. mostly in adult than peds
Intracranial aneurysm
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.
What does PEEP do to ICP?
> ICP blood backs up into brain
BEWARE: what can N2o cause for craniotomy?
tension pneumocephalus = nitrous in the air filled space and no good man
Emergence techniques to prevent intraoptive hemorrhage
- do not reverse until head dression on
- 1.5 mg/kg lido 90 before extub
- labetalol or Esmolol or NTG
