Welliver Paper Questions-Josh Flashcards
Discuss the goals associated w/ anesthestic management that is associated w/ intracranial tumor debulking:
what are the 2 main goals to optimize cerebral circulation and Oxygenation?
- maintain or acheive normal ICP
- Maintaining CPP at minimum 70 mmHg
Discuss the goals associated w/ anesthestic management that is associated w/ intracranial tumor debulking:
why would you want to avoid narcotics preop?
- depress respiratory fxn and raise PCO2 causing cerebral vasodilation and thus increased ICP
List the S/S of elevated ICP:
- H/A
- Difficulty concentrating
- Memory disturbances
- Vision Disturbances
- Vertigo
- Syncope
- Nausea
- Vomiting
- Cushing Reflex
- Cushing Triad
- Sz
- Coma
Do all Intracranial tumors increase ICP
- Nope
The location of most neurosursical procedures for tumor resection is ____-tentorial and involes the ____ _______
- Supratentorial
- Cerebral Hemisphere
the cerebral hemispheres are divided by the _____- ______ fissure
(not on test per se but just in case)
Medial longitudinal
the right and left hemispheres are connected by a bundle of nerve fibers called the ______ _____
Corpus Callosum
The cerebral Cortex is compromised of the _______, ______, ______, and _______ lobes
- Frontal
- Parietal
- temporal
- occipital
_________ refers to the location of the brain stem
Infratentorial
Infratentorial consist of the ______, ______, _______, and _____ and is the major motor and sensory pathways and the cranial nerve nuclei
- Midbrain
- Medulla
- Cerebellum
- Pons
Positioning:
Infratentorial usually require a ___ or ____ position
- Prone
- Lateral
Positioning:
the Sitting position is associated w/ increased risk of _____ and excessive neck flexion
VAE
what are the 4 primary concerns during induction
Hypoxia
Hypercarbia
HTN
Hypotension
___-tension decreases CBF and risk further ischemic injury to the brain tissue
HYPOtension
____-tension risk increasing ICP ompedind adequate cerebral circulation
HYPERtension
what are the 3 primary intraoperative goals of anesthesia care fro the pt w/ elevated ICP?
- Decreasing intracranial volume to prevent further increase in ICP
- Maintaining adequate CPP (by manipulating BP)
- Decreasing CMRO2
what are 3 ways you can lower CMRO2?
- IV agents
- VAAs
- Temperature
CMRO2: IV agents
The IV agents _____, _____, and _____ all lower CMRO2
- Thiopental
- etomidate
- propofol
CMRO2: IV agents
how do the IV agents lower CMRO2?
- The mdulation of GABA receptors lowers neuronal activity whch corresponds w/ lower Cerebral O2 consumption
CMRO2: IV agents
____ coma is sometimes induced to maximally supress CMRO2 and is reflected by an isoelectric EEG
Barbiturate
CMRO2: VAA
VAAs decrease _____ and increase _____
CMRO2
CBF
CMRO2: VAA
how do VAAs lower CMRO2
- they decrease neuronal activity which lowers O2 and Glucose consumption by brain tissue,
- the Vasodilatory effects provide additional O2 to the brain
CMRO2: Temperature
Some CRNA’s allow a mild _____ in body temperature to help lower CMRO2
decrease
CMRO2: Temperature
Each __C in body temp corresponds to a __-__% decrease in CMRO2
- 1
- 7-8%
CMRO2: Temperature
what is the rational for the hyPOthermia
- to lower CMRO2 and metabolite formation in order to protect brain tissue, but this remains controversal