Neuro anesthesia exam 2
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Clinical feature of Anterior cerebral artery occlusion
contralateral leg weakness
Clinical feature of Middle Cerebral Artery occlusion
- Contralateral hemiparesis and hemisensory deficit (face and arm > leg)
- Contralateral visual field defect
Clinical feature of Posterior Cerebral Artery Occlusion
- Contralateral visual field deficit
- Contralateral hemiparesis
Clinical feature of Basilar Artery occlusion
occulomotor deficits and or ataxia with crossed sensory and motor deficits
Clinical feature of vertebral artery occlusion
Lower cranial nerve deficits and or ataxia with crossed sensory and motor deficits
Actions the anesthetist takes for VAE
- 1. Surgeon floods the field and applies occlusive dressing to operative site/bone edges
- 2. Aspiration from right atrial catheter
- 3. Hemodynamic support
- 4. D/C N2O
- 5. Hyperbaric therapy
What is central pontine mylenolysis?
- It is associated with hypertonic saline use. Nerve damage to the cell's mylein shealth in the pons results in:
- Acute paralysis
What are some reasons for slow wake ups in neuro cases?
- Residual NMB
- Residual sedatives
- tension pneumocephalus
What is the most common cause for hydrocephalus?
Cerebral aqueduct stenosis
sudden LOC, paralysis, headache, opthalmoplegia from ruptured blood vessels in brain associated with pituitary tumors.
paralysis or weakness of one or more of the muscles that controls eye movements
Name the four types of astrocytomas
- 1. Glioma
- 2. Pilocystic astrocytoma
- 3. anaplastic astrocytoma
- 4. glioblastoma multiforme
What condition can cause bilateral acoustic neuromas?
Pituitary tumors occur with what other pathology and occur as a part of what syndrome?
Parathyroid and pancreatic islet cell tumors
Multiple endocrine neoplasia Type 1
What is the most common pediatric primary malignant brain tumor?
What are the types of primitive neuroectodermal tumors?
- 1. retinoblastoma
- 2. medulloblastoma
- 3. pineoblastoma
- 4. neuroblastoma
The prognosis is very good for these tumors
Where are the two most common primary sites of metastasis for brain tumors?
Breast and lung
Malignant melanomas, colon cancers, and hypernephromas are also common sites
What is unique about meningiomas?
They are slow-growing tumors that are found outside of the brain proper and draw their blood supply from the external carotid artery
Where are ependymoma's most commonly found?
On the floor of the fourth ventricle
Sx: ataxia, HA, N/V, obstructive hydrocephalus
What cells do oligodendroglioma tumors arise from?
myelin producing cells
Seizures are the hallmark for this tumor
How does baclofen work?
Potentiates GABA, which inhibits the involuntary muscle spasms
Acute spinal cord injury occurs in what percent of all major trauma victims?
Reduction in BP from spinal cord injury from?
- decrease in SVR b/c of loss of SNS innervation
- Bradycardia from loss of T1- T4 cardiac acceleration fibers
What is the major cause of morbidity and mortality in spinal cord injury patients?
alveolar hypo-ventilation combined with inability to clear secretions
Which muscles are responsible for forced inspiration?
external intercostals and diaphragm
What are the 5 criteria to clear a cervical spine?
- 1. No midline cervical tenderness
- 2. No focal neuro deficits
- 3. Normal sensorium
- 4. No intoxication
- 5. No distracting injury
Where is cervical spine movement during DL most likely to be concentrated?
the occipito-atlanto-axial area
In addition to baclofen, what drugs also facilitate the inhibitory effects of GABA?
Diazepam and benzodiazepines
What are the two hallmarks of autonomic hyperreflexia?
Reflex Bradycardia and hypertension
What level of the spinal cord is associated with the highest incidence of autonomic hyperreflexia with cord transection?
T 10 and below can be pretty sure it won't happen
Greater splanchnic nerve innervation from
T5 to T9
Lesser splanchnic nerve innervation from
T 10- T 11
Least splanchnic nerve innervation from
How do you treat Autonomic hyperreflexia?
Epidural is less effective than epidural, but who wants to put a spinal in a spinal cord patient?
Name the four compartments of the cranial cavity
- Cells- neurons, glia, tumors, extravasated blood
- Fluid- intracellular and extracellular
Which compartment do we have the most control during an anesthetic?
What should your goal map be?
Keep MAP at 10% within awake values
Name the four pathways for herniation
- 1. subfalcine
- 2. uncal
- 3. cerebellar
- 4. transcalvarial
What is the normal CBF?
What CBF is associated with failure and structural damage?
< 20-25 ml/100g/min
What vessels do TCD detect thru the temporal bone window?
Anterior cerebral, anterior communicating, posterior cerebral, posterior communicating, middle cerebral
What vessels do TCD detect thru the back of the flexed neck?
Basilar, opthalmic, internal carotids
EEG monitoring definition
surface recordings of summation of excitation and inhibitory post synaptic potentials generated by pyramidal cells in the cerebral cortex
Size or voltage of signal
number of times signal oscillates
duration of the sampling of the eeg signal
Parietally and frontally
Children, sleeping adults
Infants, sleeping adults
Epilepsy on EEG shows up like:
high voltage spikes with slow waves
Ischemia shows up like this on EEG
slowing frequency with preservation amplitude of loss of amplitude (severe)
Gold standard for intra-op EEG monitoring
continuous visual inspection of a 16-32 channel analog EEG by experienced electroencephalographer
0.3 MAC does this to the EEG
increases frontal beta activity
low voltage, high frequency
0.5 MAC does this to the EEG
Larger voltage, slower frequency
1 MAC does this to the EEG
irregular slow activity
1.25 MAC does this to the eeg
Very deep anesthesia 1.6 MAC does this to EEG
Burst suppression, eventually isoelectric
How does isoflurane alter the EEG?
burst suppression is easily acheivable
Why can't benzodiazepines cause burst suppression with EEG monitoring?
You can't give enough to elicit a coma, you'd kill the patient first
tonic clonic movements that are not necessarily a seizure.
Can be caused by brevital or etomidate
Which IV anesthetic agents can cause EEG suppression?
barbituates, propofol, and etomidate
Name non-anesthetic factors affecting EEG
- occlusion of major cerebral vessel
- surgically induced emboli to the brain
- retraction on cerebral cortex
time from stimulus to onset of sensory evoked potential
Which tract do sensory evoked potentials run on?
- dorsal column
Name the three types of sensory evoked potentials?
- Somatosensory (SSEP)
- Auditory (BAEP)
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