Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anesthesia & Coexisting Disease > Final_Brain > Flashcards

Final_Brain Flashcards

1
Q

CPP

A

= MAP - ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Autoregulation

A

ability of brain to maintain CBF at constant levels despite changes in CPP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When CPP is increased, arterial ____ occurs

A

constriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When CPP is decreased, arterial ____ occurs

A

dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

rapid lowering of BP in HTN patients can cause

A

cerebral ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Changes in CMRO2 usually leads to _____

A

same direction changes in CBF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

VA effect on CBF and CMRO2

A

CBF: dose-dependent increase
CMRO2: decrease
*different from norm “CBF-CMRO2 coupling”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

VA effect on ICP: most to least

A

Increases ICP

Des > Sevo, Iso

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

VA effect on CBF: most to least

A

Increases CBF

Des > Sevo > Iso

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

VA effect on CMRO2: most to least

A

Decreases CMRO2

Iso > Des/Sevo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to offset VA effect on CBF?

A

Arterial hypocapnea helps to minimize increases in CBF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Normal CPP

A

50-150 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

poor mans way to calculate CPP

A

substitute ICP for CVP

CPP=MAP-CVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Brain receives how much cardiac output

A

15%

or 750 mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CMRO2 of brain

A

3mL O2/g brain tissue/min

  • 50mL/min
  • 18-23% of total body O2 consumption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hypocapnea can effect cerebral blood flow how?

A

acutely decrease: CBF, CBV, ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

1 mmHg increase in PaCO2 = ______ CBF

A

15 mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

As _____ returns to normal, hypocapnea is no longer effective at decreasing CBF, CBV, ICP

A

CSF pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PaO2 effect on CBF?

A

Decreased PaO2:
-Increases cerebral vasodilation + CBF
Only effects CBF when PaO2 < 50 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Nitrous Oxide effect on brain

A

increases ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ketamine effect on brain

A

cerebral vasodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Propofol effect on brain

A

cerebral vasoconstrictor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Opioid effects on brain

A

cerebral vasoconstrictor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

NDMR effects on brain

A

prevent coughing = avoid acute increase in ICP

25
When to decrease ICP
Tx sustained ICP > 20
26
Methods to decrease ICP
``` Elevate HOB Hyperventilate CSF drainage Surgical decompression hyperosmotic Rx Diuretics Corticosteroids Cerebral vasoconstricting agents ```
27
Fastest intervention to decrease ICP
hyperventilation
28
Cerebral vasoconstriction results in
reduced CBF/CBV
29
Hyperventilation to decrease ICP: goal
PaCO2 25-35
30
Hyperosmotic Rx
``` Mannitol -0.25-0.5mg/kg: removes 100mL h2O from brain -decreased ICP seen w/in 30min U/O up to 1-2L Hypertonic Saline -CVL, caution w/ rapid admin -1-2mL/kg of 3% over 5min *check serum Na prior! (hold if Na>160) ```
31
Sux effect on brain
increased in ICP, CBF
32
When to use lasix vs. mannitol
Lasix: good for pt who cannot tolerate transient increase in intravasc volume
33
Corticosteroids effect on ICP
Decreases - for localized vasogenic cerebral edema/pseudomotor cerebri
34
Effective treatment to decrease ICP in acute head injury pts
Barbiturates
35
Anesthetic considerations for intracranial tumors
- Identify if increased ICP present - sensitive to sedation/opioids - combo: NO, VAs, opioids, barbiturates, propofol
36
Intraop goals for increased ICP
- pre-treat for increased ICP - control BP thru induction - deep before induction - profound muscle relaxation: DL/intubation - Euvolemia, avoid dextrose - rapid emergence
37
Induction agents - increased ICP
Propofol + barbiturates
38
Special monitoring for intracranial tumors
PIV, A-line, EEG
39
Delay of elective surgery post stroke
Elective surgery should be delayed for up to 9 months (allow return of cerebral autoregulation)
40
periop stroke associated with
8x increase risk of death within 30 days of surgery
41
Sitting position does what to CPP?
Decreases CPP by ~ 15%
42
Advantages of sitting position
Surgical exposure, enhanced venous drainage, minimize EBL, decreases ICP
43
Disadvantages of sitting position
HOTN, decreased CO, risk of VAE
44
How does HOB elevation effect hemodynamics?
1mmHg drop in MAP per 1.25 cm increase in HOB elevation
45
supratentorial tumor resection is done in which position?
sitting
46
When could a VAE occur?
When exposed veins are above the level of the heart
47
Why does a VAE occur?
Veins: - don't collapse when cut d/t attachment to bone/dura - are sub-atmospheric pressure
48
VAE: Air into RA
interferes with R-sided co + pulm arterial blood flow --> bronchoconstriction/pulm edema
49
VAE: Air Lock
R-sided output failure, acute cor pulmonale, hypoxemia
50
VAE: caution with who?
R-L shunt (paradoxical air embolism: obstruction of coronaries with air= vfib/death)
51
S/S VAE
Sudden decrease in ETCO2 Gasp reflex Millwheel murmur TEE Late: HOTN, tachycardia, dysrhythmias, cyanosis
52
Tx: VAE
CRNA - Notify surgeon/Call for help ASAP - Aspirate RAC - d/c N2O, admin. 100% FiO2 Surgeon - flood site with fluid - apply occlusive material to bone edges
53
SAH: Tx
- MRI/MRA localization - percutaneous radiology techniques (control bleed: via coil/clip) - outcome optimal w/in 72h of bleed
54
Day 3-15 after SAH, risk of
cerebral vasospasm goal: HTN, hypervolemia, hemodilution Tx: Nimodipine CCB day 1-21
55
SAH clipping: anesthetic management
induction: avoid increasing ICP Maintenance: A-line, CVP, PA catheter or TEE (CV dx), EP monitoring (detect ischemia)
56
Goals of SAH clipping aesthetic management
- Depth of anesthesia appropriate to level of stimulation - Facilitate surgical exposure: brain relaxation - Maintain CPP - Reduce aneurysm transmural pressure - Prompt awakening of pt post-procedure - Drugs, fluids, blood must be immediately available in event of rupture
57
Biggest risk during AVM intraop
severe/rapid hemorrhage
58
AVM anesthetic considerations
- pre-induction A-line - tight BP control - fluid/blood readily available

Anesthesia & Coexisting Disease (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions