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Monitorinig FInal BRAIN > BRAIN > Flashcards

BRAIN Flashcards

1
Q

inadequate oxygen in body tissue

A

hypoxia

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2
Q

inadequate blood supply in body tissue

A

ischemia

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3
Q

the medical condition of having an

unusually low level of sugar in the blood

A

hypoglycemia

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4
Q

hyperglycemia

A

the medical condition of having an unusually high

level of sugar in the blood

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5
Q

Ischemia Morbid Neurological Outcomes

Type 1 Types?

A

Cerebral Death
Non-fatal strokes
New TIA’s

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6
Q

Ischemia Morbid Neurological Outcomes

Type 2 Types?

A

New intellectual deterioration

New seizures upon discharge

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7
Q

Type I Predictors (4)

A

Advanced age
Aortic atherosclerosis
History of prior neurologic events–15%
Carotid stenosis

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8
Q

Type 1 Predictor Advanced age % risks

A

Advanced age
Independent of other factors predisposes to stroke
< 60 : 1% risk
> 70 : 4 to 9% risk

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9
Q

Type II Predictors (6)

A 
Low cardiac output states
Atrial arrhythmias
Systolic Hypertension
Diabetes
Pulmonary Disease
Excessive Alcoholism
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10
Q

Neuro Impairment

A

6.1% - prevalence of CVS complication

Stroke, stupor, coma, deterioration in intellectual function, memory deficit or seizures

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11
Q

Post-Op Delirium

A

10-60% prevalence of CVS complication
Depending on patient age and type of surgery
These patients have an LOS of 20-25 days vs. 10 days for patients with no adverse outcomes

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12
Q

Post-Op Delirium LOS?

A

Patients have an LOS of 20-25 days vs. 10 days for patients with no adverse outcomes

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13
Q

Incidence of Neurologic Dysfunction

Permanent complications %

A

1.6 - 23%

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14
Q

Perfusion Contributes Focal

Embolism Types

A 
Air
Plaque
Microemboli
Left ventricular thrombus
Fat
Debris
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15
Q

Ischemia Reperfusion Injury

A

potent triggers for: activation of leukocyte, leukocyte-endothelial or leukocyte endothelial platelet binding

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16
Q

Tailoring Oxygen Delivery

HOW?

A 
Mean Arterial Pressure
CO2
Cardiac Index and Pump Flow
Hematocrit
Mechanical Issues
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17
Q

Tailoring Oxygen Consumption

HOW?

A
  • Anesthetic Agent and Depth

* Temperature

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18
Q

Detection of cerebral ischemia and administration of pharmacologic agents to provide cerebral protection depend on:

A

accurate, reliable monitoring of cerebral

electrical activity

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19
Q

ICP

A

Intra-cranial pressure monitoring

type of brain monitoring

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20
Q

rSO2

A

Regional Saturation of Oxygen

type of brain monitoring

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21
Q

TCD

A

Transcranial Doppler

type of brain monitoring

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22
Q

BIS

A

Bispectral Index

type of brain monitoring

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23
Q

SjVO2

A

Saturation of Jugular Venous Oxygen

type of brain monitoring

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24
Q

Invivo Optical Spectroscopy

A

INVOS Somanetics Cerebral Oximetry

type of brain monitoring

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25
Q

EEG

A

Electroencephalogram
Reflects correlated synaptic activity caused by post-synaptic potentials of cortical neurons
Each lead covers a surface area of 2.5cm

26
Q

EEG Signal is generated by –

A

amplifying voltage differences between pairs of electrodes

27
Q

EEG Electrodes

A 
21 International 10-20 electrodes are standard
OR: 2-4 lead monitoring
Placed over the cerebral artery
Odd numbers 1,3,5,7 = left hemisphere
Even numbers 2,4,6, 8 = Right hemisphere
28
Q

EEG abnormalities due to old injuries %

A

It is not uncommon for 15% of the population to show abnormalities due to old injuries.

29
Q 
Rhythm: Alpha
 Frequency  - 
Predominant Amp -
Location - 
Physio state -
A

8-13Hz
Medium (Amp)
Occiput
Relaxed, awake

30
Q 
Rhythm: Beta
 Frequency  - 
Predominant Amp -
Location - 
Physio state -
A

13-30Hz
Low
Frontal
Alert, awake

31
Q 
Rhythm: Theta
 Frequency  - 
Predominant Amp -
Location - 
Physio state -
A

4-8Hz
High
Diffuse
Sleeping infant, child

32
Q 
Rhythm: Delta
 Frequency  - 
Predominant Amp -
Location - 
Physio state -
A

0-4Hz
High
Diffuse
Metabolic coma, cerebral ischemia, normal deep sleep, deep anesthesia

33
Q

EEG Clinical Usage - Main Reason

A

Epilepsy
Brain Tumors
Stroke
Focal brain disorders

34
Q

EEG Clinical Usage - Secondary reason

A

Diagnosis of coma
Encephalopathies
Brain death

35
Q

EEG signal information is generated from voltages

A

50-100 μV in the electrically hostile operating room environment

36
Q

BIS

A

Processed EEG information as a measure of sedative
effects of anesthesia medications
Information displayed every 10-15 seconds
Most validated measure of consciousness available
Graphical trend and numerical value
Non-invasive, continuous, direct and real time

37
Q

BIS Index

A

The index is a number
between 1 and 100
100 is a fully awake patient

38
Q

BIS Value of 80

A

Light/Moderate Sedation

May respond to loud commands or mild prodding/shaking

39
Q

BIS Value of 60

A

General Anesthesia
Low probability of explicit recall
Unresponsive to verbal stimulus

40
Q

BIS Value of 40

A

Deep Hypnotic State

41
Q

BIS Value of 20

A

Burst Suppression

42
Q

BIS Value of 10

A

Flat Line EEG

43
Q

Target BIS Value when Using opioid anesthesia with supplementation with volatile gas on pump

A

Normal 25-35

TARGET to titrate to 45-55

44
Q

BIS Benefits

A 
Reduction in primary anesthetic use
Decrease incidence of intraoperative awareness and
recall
Reduction in emergence and recovery time
Improved patient satisfaction
45
Q

BIS Disadvantages

A

It is a trending device
We can’t be responsible to treat the level of sedation
Often monitor only faces anesthesia

46
Q

Transcranial cerebral oximetry

A

non-invasive technique for monitoring changes in cerebral oxygen metabolism, which presents additive information when the conventional key variables (as peripheral oxygenation and/or systemic hemodynamics) would not be predictive.

47
Q

INVOS System

Invivo Optical System

A

-Noninvasive, continuous, direct, real time
-Site-specific (regional) measure vs systemic; often signals earlier warning of reversible ischemia
-Not pulse, pressure or temperature dependent
-Added ability to detect and correct oxygenation issues that
can lead to complications and poor outcomes
-Identifies patient-unique rSO2 baselines for customized care

48
Q

Major Organ Morbidity or Mortality (MOMM) %

A

13.4%

49
Q

MOMM cumulative score of

A 
Death within 30 days
Renal failure requiring dialysis
Permanent stroke
Re-operation for any reason
> 48 hours ventilation
Mediastinitis/deep sternal infection
50
Q

INVOS System monitoring drops MOMM

A

3%

51
Q

Despite increased patient acuity and inherent

complications, payors, quality/reporting organizations and consumers all expect patient outcomes to

A

continually improve

52
Q

Prolonged Ventilation: %

A

5.96%

Greater than 48 hours

53
Q

Cognitive Decline: %

A

24-53%

53% at discharge, 36% at 6 weeks, 24% at 6 months
and 42% at 5 years; indicating it is not transitory

54
Q

Somanetics Monitor

Critically important to set the baseline before

A

anesthesia induction and nasal oxygen

55
Q

Near infrared spectroscopy light can penetrate all cranial tissue layers

A

650-1100nm

56
Q

Cerebral rSO2

A

detects O2 supply issues associated with inflow obstructions

Most useful for venous cannula obstruction

57
Q

Cerebral rSO2 Inflow Issues

A

Head Position
Heart Position
Arterial Obstruction (Carotid Disease, Clamp, Hand, Sponge)
Cannula Malposition

58
Q

Cerebral Inflow Issues - Increase Supply - Oxygen Delivery

A 
Increase blood pressure
Normalize CO2
to physiologic level
Increase FiO2
Increase cardiac output (pump flow)
Vasodilate cerebral blood vessels
Increase hematocrit
59
Q

rSO2 Critical Threshhold

A

less than or equal to 40
or
25% drop from baseline

60
Q

rSO2 Intervention Threshold

A

less than or equal to 50 or 20% drop from baseline

61
Q

rSO2 Normal Cardiac

A

rSO2 47-83 baseline

Monitorinig FInal BRAIN (1 decks)

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