Term
T or F:
1) All volatiles dilate cerebral vessels and increase CBF except Halothane.
2) All volatiles dose-dependently reduce CRMO2
3) All volatiles dose-dependently increase autoregulation
4) Halothane increases CBF 200% and reduces autoregulation the most |
|
Definition
1) F: All volatiles dilate cerebral vessels and increase CBF
2) T
3) F: All volatiles impair autoregulation (dose dependent)
4) T |
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Term
T or F:
Isoflurane increases CBF the least, reduces CMRO2 the most, and also reduces CSF |
|
Definition
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Term
| List 4 reasons Gayle gives as to why you wouldn't want to use N20 in neuroanesthesia |
|
Definition
1) increases CBF and ICP
2) increases intracranial air
3) increases VAE size
4) increases pneumothorax size
*jeez, just don't use it if possible. |
|
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Term
T or F:
According to M&M, of all anesthetic agents, barbiturates decrease cerebral blood flow the most |
|
Definition
False. Propofol decreases CBF the most. Barbs decrease CMRO2 the most.
*Morgan & Mikhail, p 558 |
|
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Term
| Aside from cardiovascular stability, what else should we know about Etomidate? |
|
Definition
1) Reduces CMRO2 and CBF
2) may produce adrenal suppression (up to 24hrs after single induction dose)
3) may activate seizure foci in epileptics |
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Term
How does propofol reduce CMRO2, CBF, and ICP?
|
|
Definition
| via cerebral vasoconstriction |
|
|
Term
| How does propofol reduce MAP? |
|
Definition
| via peripheral vasodilation |
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|
Term
| Why is ketamine not a good choice for neuroanesthesia? |
|
Definition
1) increases CBF by 50-60%
2) impedes CSF absorption
3) promotes seizure activity |
|
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Term
T or F:
Benzos elevate seizure threshold |
|
Definition
|
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Term
| List some interesting neuroanesthetic effects of barbiturates. |
|
Definition
* reduces CRMO2
* reduces CBF (pentothal vasoconstricts cerebral vessels)
* although CBF is reduced, CRMO2 is reduced more, leaving supply & demand for O2 intact.
* have anticonvulsant activity (except methohexital) |
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Term
| What effects do opioids have on CBF? ICP? or CMRO2? |
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Definition
| opioids have minimal effects on CBF, ICP, or CMRO2 although hypoventilation produces hypercarbia. |
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Term
| Name two opioids that can produce seizures |
|
Definition
Alfenta - can activate seizure foci
Demerol - its metabolite (normeperidine) promotes siezure activity |
|
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Term
| Does succinylcholine increase ICP? |
|
Definition
Hell yes.
This is independent of fasciculation.
*this is limited if a defasciculating dose of NDMR is given |
|
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Term
| You walk into a bar and see Sam dancing. You mistake his "moves" for seizure activity. Knowing a seizure increases CMRO2, what kind of drugs could you first give him to slow his ass down? |
|
Definition
Midazolam 1-5 mg
Pentothal 25-100 mg
Diazepam 2-20 mg |
|
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Term
| What types of monitoring would you find during your neuro cases? |
|
Definition
outside of the standards:
*art line - for ABGs
* CVP - for fluid management, VAE treatment, check fluid status
* EEG |
|
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Term
T or F:
Sensory Evoked Potentials (SEPs) evaluate ascending sensory pathways (touch, pressure, vibration) in the anterior cord and crebral cortex. |
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Definition
| False. This pathway is carried in the posterior cord. |
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