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Flashcards in Welliver Paper Questions-Josh Deck (63)
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1

Discuss the goals associated w/ anesthestic management that is associated w/ intracranial tumor debulking:

what are the 2 main goals to optimize cerebral circulation and Oxygenation?

 

  1. maintain or acheive normal ICP
  2. Maintaining CPP at minimum 70 mmHg

 

2

Discuss the goals associated w/ anesthestic management that is associated w/ intracranial tumor debulking:

why would you want to avoid narcotics preop?

  • depress respiratory fxn and raise PCO2 causing cerebral vasodilation and thus increased ICP

3

List the S/S of elevated ICP:

 

  • H/A
  • Difficulty concentrating
  • Memory disturbances
  • Vision Disturbances
  • Vertigo
  • Syncope
  • Nausea
  • Vomiting
  • Cushing Reflex
  • Cushing Triad
  • Sz
  • Coma

4

Do all Intracranial tumors increase ICP

  • Nope

5

The location of most neurosursical procedures for tumor resection is ____-tentorial and involes the ____ _______

  • Supratentorial
  • Cerebral Hemisphere

6

the cerebral hemispheres are divided by the _____- ______ fissure

(not on test per se but just in case)

Medial longitudinal

7

the right and left hemispheres are connected by a bundle of nerve fibers called the ______ _____

Corpus Callosum

8

The cerebral Cortex is compromised of the _______, ______, ______, and _______ lobes

  1. Frontal
  2. Parietal
  3. temporal
  4. occipital

9

_________ refers to the location of the brain stem

Infratentorial

10

Infratentorial consist of the ______, ______, _______, and _____ and is the major motor and sensory pathways and the cranial nerve nuclei

  • Midbrain
  • Medulla
  • Cerebellum
  • Pons

11

Positioning:

Infratentorial usually require a ___ or ____ position

  • Prone
  • Lateral

12

Positioning:

the Sitting position is associated w/ increased risk of _____ and excessive neck flexion

VAE

13

what are the 4 primary concerns during induction

Hypoxia

Hypercarbia

HTN

Hypotension

 

14

___-tension decreases CBF and risk further ischemic injury to the brain tissue

HYPOtension

15

____-tension risk increasing ICP ompedind adequate cerebral circulation

HYPERtension

16

what are the 3 primary intraoperative goals of anesthesia care fro the pt w/ elevated ICP?

  1. Decreasing intracranial volume  to prevent further increase in ICP
  2. Maintaining adequate CPP (by manipulating BP)
  3. Decreasing CMRO2

17

what are 3 ways you can lower CMRO2?

  1. IV agents
  2. VAAs
  3. Temperature

18

CMRO2: IV agents

The IV agents _____, _____, and _____ all lower CMRO2

  1. Thiopental
  2. etomidate
  3. propofol

19

CMRO2: IV agents

how do the IV agents lower CMRO2?

  • The mdulation of GABA receptors lowers neuronal activity whch corresponds w/ lower Cerebral O2 consumption

20

CMRO2: IV agents

____ coma is sometimes induced to maximally supress CMRO2 and is reflected by an isoelectric EEG

Barbiturate

21

CMRO2: VAA

VAAs decrease _____ and increase _____

CMRO2

CBF

22

CMRO2: VAA

how do VAAs lower CMRO2

  • they decrease neuronal activity which lowers O2 and Glucose consumption by brain tissue,
  • the Vasodilatory effects provide additional O2 to the brain

23

CMRO2: Temperature

Some CRNA's allow a mild _____ in body temperature to help lower CMRO2

decrease

24

CMRO2: Temperature

Each __C in body temp corresponds to a __-__% decrease in CMRO2

  • 1
  • 7-8%

25

CMRO2: Temperature

what is the rational for the hyPOthermia

  • to lower CMRO2 and metabolite formation in order to protect brain tissue, but this remains controversal

26

CMRO2: Temperature

there is no conclusive objective data stating that supports the use of  HYPOthermia as an independent varible that decreases morbidity and mortality for a pt w/ space occupying lesions. This being said _______ should be avoded as it has been found to be detrimental

Hyperthermia

27

Explain the word "Coupling" in relationship of CMRO2 to CBF

  • coupling is the direct relationship of CMRO2 and CBF
  • an INCREASE in one corresponds to an INCREASE in the other.
  • thus during normal activity increases in cerebral metabolic activity will corrolate w/an increase in CBF

28

"Coupling"

_____, _____, and ____ all decrease CMRO2 and allow normal regulatory decreases in CBF (aka Coupling)

Hint answers are meds

  • Benzo
  • Barbs
  • Prop

29

"Coupling"

what and how does VAAs do to Coupling

  • Uncouple
  • they disrupt or "uncouple" this relationship by decreasing CMRO2 while increasing CBF
  • Basicallly change the direct relationship of CMRO2 and CBF to an inverse relationship

30

If VAAs decrease CMRO2 why do we only ise 1/2 MACs?

  • A decrase in CMRO2 is beneficial to ischemic brain tissue , but increases in CBF may cause detrimental increases in ICP and possibly divert blood flow away from ischemic areas to non-ischemic areas. AKA Steal phenomenon