Topics To Review

Question 1

Increased Intra Occular Pressure vs Increased Intracranial Pressure

Answer 1

Increased Intraoccular Pressure Caused by:

Hypoventilation, hypoxemial increased CVP (big time) Increased arterial pressure.

Ketamine (possibly)
Succinylcholine

Straining/ coughing / vomitting / nystagmus

Differences with regards to ICP:

• Volatiles DECREASE IOP and may increase ICP

Question 2

Describe the Occulocardiac Reflex

Answer 2

The afferent limb is the trigeminal and the efferent limb is the vagus nerve

Reflex is triggered often by pressure on the globe and by traction on the extra extraoccular muscles / conjuctiva / orbital structures

Most common rhythm as a result of the reflex is bradycardia, but lots of others may occur, including junctional rhythm, ectopic atrial rhythm, AV block, Ventricular bigeminy, PVCs, wandering pacemaker, idioventricular rhythm, asystole and v-tach.

Question 3

Revised Cardiac Risk Score

Answer 3

Risk for cardiac death, nonfatal myocardial infarction, and nonfatal cardiac arrest:
0 predictors = 0.4%, 1 predictor = 0.9%, 2 predictors = 6.6%, ≥3 predictors = >11%

1. History of ischemic heart disease
2. History of congestive heart failure
3. History of cerebrovascular disease (stroke or transient ischemic attack)
4. History of diabetes requiring preoperative insulin use
5. Chronic kidney disease [creatinine > 2 mg/dL (176.8 µmol/L)]
6. Undergoing suprainguinal vascular, intraperitoneal, or intrathoracic surgery (ie High risk Surgery)