Flashcards in EXAM 1 Deck (45)
Autoregulation of cerebral blood flow remains nearly constant between a mean arterial pressure of about 70-150 mmHg. (T or F)
Cerebral blood flow (CBF) is approximately:
Agents that are useful in decreasing CMRO2 include all of the following EXCEPT
Cerebral blood flow decreases about ________% for every 1 degree Celcius __________ in body temperature
Which of the following reasons is the MOST IMPORTANT reason to avoid preoperative sedation in patients with suspected increased ICP?
sedation may cause hypoventilation leading to hypercarbia
Which of the following describe functions of neuroglial cells?
all of the above are correct
Determinants of cerebral blood flow include:
All of the following are true about intracranial pressure EXCEPT:
normal ICP is 10 - 20 mmHg, and intracranial hypertension is a sustained ICP greater than 25-30
Which of the following are maneuvers / interventions that can be used by the anesthetist to decrease intracranial volume and ICP?
provide moderate hyperventilation
A 55 year old patient presents to the operating room for emergent craniotomy. According to her husband, she has been complaining of a headache for about 6 months and he noticed she had increasing memory loss during that time. Over the last couple days, she has had worsening hemiplegia, a decline in cognitive function and is now aphasic. She experienced a seizure 30 minutes ago in the emergency department. She had a CT before being transported to the operating room. Even before reviewing the CT report, you suspect the patient has:
a symptomatic supratentorial space occupying lesion
Which of the following statements is true regarding monitors to detect venous air embolus?
End-tidal nitrogen is specific to air AND detects air earlier than ETCO2
A 72 year old woman prsents to the Emergency department with sudden onset, severe headache described as the worst headache of her life, nausea, vomiting, photophobia. There are focal neurological deficits on exam. As the patients is being taken to CT, you are called to accompany the patient in case of further deterioration in status and the likely trip to the operating room. You suspect that the pateint has suffered:
an intracranial hemorrhage
Which of the following are indications for tracheal intubation in the head trauma patient?
a, b, and c
Which of the following statements is TRUE regarding neurosurgical procedures in the sitting position?
Pressors may be required to maintain adequate blood pressure
What is the cerebral perfusion pressure when the ICP = 12, CVP = 6, and the MAP = 114?
Match the BIS values with the appropriate level of consciousness
60 - 70 Deep Sedation
40 - 60 General Anesthesia
70 - 80 light / moderate sedation
0 flat line EEG
Risk factors, or contributing factors, for awareness under anesthesia include which of the following:
all of the above
The Basilar artery and the middle cerebral artery are two of the vessels that compose the Circle of Willis. (T or F)
Which of the following statements about cerebral oximetry is true?
cerebral oximetry decreases during cerebral ischemia due to increased oxygen extraction
Volatile anesthetics increase the latency and decrease the amplitude of evoked potentials. (T or F)
Somatosensory evoked potentials (SSEPs) measure the intactness of the _________ pathways.
Because anesthetics can not affect SSEPs, it is not necessary for the anesthetist to communicate changes in the anesthetic to the electrophysiology monitor. (T or F)
You are the anesthetist for a posterior discectomy and fusion at L1-5 in the prone position. The neuromonitor technician informs you that the SSEPs are decreased. Vital signs and anesthetic specifics are as follows:
BP 85/40 (preop was 135/62), HR 80 (baseline was 78), Spo2 98%, Cerebral oximeter 65 and 63 (baseline was 80 and 78), BIS/entropy 55.
FiO2 .6, ET Sevo 1.0, propofol 50 mcg/kg/min, remifentanil .025 mcg/kg/min.
Based on your knowledge of neuromonitoring and CBF, what would be the most appropriate intervention?
adminisiter a vasoporssor such as phenylephrine
Brain stem auditory evoked potentials are most useful during which of the following types pf surgery?
transphenoidal or anterior fossa surgery
Goals of anesthetic management of the patient having a carotid endarterectomy include:
all of the above
Which of the following tests of nerve function correlates with the lowest percentage of Ach receptors that are occupied during the recovery from a nondepolarizing muscle relaxant?
head lift x 5 seconds
Spinal anesthesia should be avoided in patients with multiple sclerosis becuse it exacerbates symptoms. (T or F)
Based on your understanding of the pathophysiology of Duchenne's Muscular Dystrophy, which of the following should be conducted as part of the preoperative preparation of a patient with DMD?
ECG and echocardiography
Choose all of the following statements that are TRUE:
Lambert-Eaton Myasthenic Syndrome is an autoimmune disorder classically occuring in patients with malignancies, especially of the lung.
Succinylcholine should be avoided in patients with multiple sclerosis to avoid the risk of succhinylcholine-induced hyperkalemia which can result in a fatal cardiac arrhythmia.
Patients with Duchenne's Muscular Dystrophy often exhibit slowed gastric emptying and weakened pharyngeal muscles, making them at risk for aspiration.