Miller Questions

Question 1

What is the arterial blood supply to the brain?

Question 2

.In what proportion of human brains is the classic depiction ofthe circle of Willis found

Question 3

What make up the blood-brain barrier?

Question 4

Name some factors that influence cerebral blood flow.

Question 5

What is normal cerebral blood flow

Question 6

What is the relationship between cerebral metabolic rate and cerebral blood flow?
8. For every 1 C decrease in temperature below normal body temperature, what is the
corresponding decrease in cerebral blood flow?

Question 7

Define cerebral perfusion pressure

Question 8

Within what range of mean arterial pressures will cerebral blood flow remain
relatively constant

Question 9

What is the time course within which cerebral vasculature changes in response to
alterations in mean arterial pressure? What is the clinical implication of this?

Question 10

What are factors that impair the autoregulation of cerebral blood flow?

Question 11

Describe the relationship between PaCO2 and cerebral blood flow.

Question 12

How much does cerebral blood flow change for every 1 mm Hg increase or decrease
in PaCO2 from 40 mm Hg?

Question 13

What is a potential risk of prolonged, aggressive hyperventilation to a PaCO2 of less
than 30 mm Hg?

Question 14

Below what PaO2 will cerebral blood flow increase?

Question 15

What are the effects of volatile anesthetics on cerebral blood flow and intracranial
pressure?

Question 16

What are the effects of nitrous oxide on cerebral blood flow and intracranial
pressure?

Question 17

What are the effects of ketamine on cerebral blood flow and intracranial pressure?

Question 18

20. What are the effects of thiopental on cerebral blood flow and intracranial pressure?

Question 19

What are the effects of propofol on cerebral blood flow and intracranial pressure?

Question 20

What are the effects of propofol on cerebral blood flow and intracranial pressure?

Question 21

22. What are the effects of etomidate on cerebral blood flow and intracranial pressure?

Question 22

What are the effects of dexmedetomidine and clonidine on cerebral blood flow and
intracranial pressure?

Question 23

What are the effects of benzodiazepines on cerebral blood flow and intracranial
pressure?

Question 24

What are the effects of opioids on cerebral blood flow and intracranial pressure?

Question 25

What are the effects of neuromuscular blocking drugs on cerebral blood flow and
intracranial pressure?

Question 26

What is a normal intracranial pressure?

Question 27

How does the body compensate for increasing intracranial pressure? What
implications does this have clinically?

Question 28

How do drug-induced increases in cerebral blood flow affect the intracranial
pressures of normal patients and of patients with intracranial tumors?

Question 29

30. Name some methods used to decrease elevated intracranial pressure

Question 30

Name some signs and symptoms that may be noted preoperatively that provide
evidence that a patient may have an increased intracranial pressure.

Question 31

What is the current recommendation regarding the use of induced hypothermia
for neuroprotection?

Question 32

What is the current recommendation regarding the use of intravenous anesthetics
for neuroprotection?

Question 33

What monitors are typically used for intracranial neurosurgery?

Question 34

What two devices can be used to measure the intracranial pressure?

Question 35

What measures can an anesthesiologist undertake to attenuate increases in arterial
blood pressure and intracranial pressure during direct laryngoscopy?

Question 36

How is maintenance anesthesia usually achieved in patients undergoing
intracranial neurosurgery?

Question 37

What minimum alveolar concentration (MAC) of volatile anesthetic should be
administered when used for maintenance anesthesia in patients undergoing
intracranial neurosurgery?

Question 38

What minimum alveolar concentration (MAC) of volatile anesthetic should be
administered when used for maintenance anesthesia in patients undergoing
intracranial neurosurgery?

Question 39

What is the desired range of PaCO2 to optimize cerebral blood flow intraoperatively?

Question 40

What is a potential problem of the administration of positive end-expiratory
pressure (PEEP) during mechanical ventilation of the lungs in patients undergoing
intracranial neurosurgery?

Question 41

How do peripheral vasodilators affect cerebral blood flow? What is the
recommendation regarding the use of these drugs intraoperatively in patients
undergoing intracranial neurosurgery?

Question 42

Why might neuromuscular blockade be maintained throughout intracranial
surgical procedures?

Question 43

How can cerebral swelling be treated intraoperatively?

Question 44

What are some potential problems that can occur with the administration of
mannitol?

Question 45

How should intravenous fluid administration be managed intraoperatively in
patients undergoing intracranial neurosurgery?

Question 46

Why should glucose-containing intravenous solutions be avoided in neurosurgical
patients?

Question 47

Why should coughing and straining by patients awakening from anesthesia be
avoided after intracranial surgery? What are some methods by which these
responses by the patient can be avoided?

Question 48

Why is rapid awakening desirable in neurosurgical procedures?

Question 49

How should delayed recovery after intracranial surgery be evaluated? When should
tension pneumocephalus be considered as a possible cause of postoperative delayed
recovery?

Question 50

Why are patients undergoing neurosurgical procedures at an increased risk for
venous air embolism?

Question 51

Why are patients undergoing neurosurgical procedures at an increased risk for
venous air embolism?

Question 52

Describe the pathophysiology of a venous air embolism. What percent of adult
patients have a probe patent foramen ovale?

Question 53

What are methods by which a venous air embolism can be detected? Which of these
is the most sensitive?

Question 54

What are some signs of a clinically significant venous air embolism?

Question 55

What is the treatment for a venous air embolism?

Question 56

Why should nitrous oxide administration be discontinued in the presence of a
venous air embolism?

Question 57

What are the advantages of a pulmonary artery catheter in the presence of a venous
air embolism?

Question 58

How efficacious is the use of PEEP in the prevention of a venous air embolism?

Question 59

What typically causes death in a fatal venous air embolism?

Question 60

What are some of the presenting signs and symptoms of patients with an
intracranial tumor?

Question 61

What are the anesthetic goals for patients undergoing surgical resection of an
intracranial tumor?

Question 62

Why is it important to limit drug-induced depression of ventilation with
preoperative medicines in patients who are scheduled to undergo surgical resection
of an intracranial tumor?

Question 63

How is the induction of general anesthesia in patients undergoing surgical resection
of an intracranial tumor achieved?

Question 64

What are the advantages and disadvantages of the sitting position for the resection
of intracranial tumors?

Question 65

Name some anesthetic considerations that are unique to posterior fossa tumors