Neuro anesthesia exam 2

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Neuro anesthesia exam 2
2015-04-13 15:49:23
spinalcord autonomicdiseases braindiseases neuromonitoring neurosurgicalmanagement

test 2
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  1. Clinical feature of Anterior cerebral artery occlusion
    contralateral leg weakness
  2. Clinical feature of Middle Cerebral Artery occlusion
    • Contralateral hemiparesis and hemisensory deficit (face and arm > leg)
    • Aphasia
    • Contralateral visual field defect
  3. Clinical feature of Posterior Cerebral Artery Occlusion
    • Contralateral visual field deficit
    • Contralateral hemiparesis
  4. Clinical feature of Basilar Artery occlusion
    occulomotor deficits and or ataxia with crossed sensory and motor deficits
  5. Clinical feature of vertebral artery occlusion
    Lower cranial nerve deficits and or ataxia with crossed sensory and motor deficits
  6. 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
  7. 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
    • Dysphagia
    • Dysarthria
  8. What are some reasons for slow wake ups in neuro cases?
    • Hypothermia
    • Residual NMB
    • Residual sedatives
    • ischemia
    • hematoma
    • tension pneumocephalus
  9. What is the most common cause for hydrocephalus?
    Cerebral aqueduct stenosis
  10. Pituitary apoplexy
    sudden LOC, paralysis, headache, opthalmoplegia from ruptured blood vessels in brain associated with pituitary tumors.
  11. Opthalmoplegia
    paralysis or weakness of one or more of the muscles that controls eye movements
  12. Name the four types of astrocytomas
    • 1. Glioma
    • 2. Pilocystic astrocytoma
    • 3. anaplastic astrocytoma
    • 4. glioblastoma multiforme
  13. What condition can cause bilateral acoustic neuromas?
  14. 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
  15. What is the most common pediatric primary malignant brain tumor?
  16. What are the types of primitive neuroectodermal tumors?
    • 1. retinoblastoma
    • 2. medulloblastoma
    • 3. pineoblastoma
    • 4. neuroblastoma

    The prognosis is very good for these tumors
  17. 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
  18. 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
  19. Where are ependymoma's most commonly found?
    On the floor of the fourth ventricle

    Sx: ataxia, HA, N/V, obstructive hydrocephalus
  20. What cells do oligodendroglioma tumors arise from?
    myelin producing cells

    Seizures are the hallmark for this tumor
  21. How does baclofen work?
    Potentiates GABA, which inhibits the involuntary muscle spasms
  22. Acute spinal cord injury occurs in what percent of all major trauma victims?
    1.5-3 %
  23. 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
  24. What is the major cause of morbidity and mortality in spinal cord injury patients?
    alveolar hypo-ventilation combined with inability to clear secretions
  25. Which muscles are responsible for forced inspiration?
    external intercostals and diaphragm
  26. 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
  27. Where is cervical spine movement during DL most likely to be concentrated?
    the occipito-atlanto-axial area
  28. In addition to baclofen, what drugs also facilitate the inhibitory effects of GABA?
    Diazepam and benzodiazepines
  29. What are the two hallmarks of autonomic hyperreflexia?
    Reflex Bradycardia and hypertension
  30. What level of the spinal cord is associated with the highest incidence of autonomic hyperreflexia with cord transection?
    T 6

    T 10 and below can be pretty sure it won't happen
  31. Greater splanchnic nerve innervation from
    T5 to T9
  32. Lesser splanchnic nerve innervation from
    T 10- T 11
  33. Least splanchnic nerve innervation from
    T 12
  34. How do you treat Autonomic hyperreflexia?
    epidural anesthesia

    Epidural is less effective than epidural, but who wants to put a spinal in a spinal cord patient?
  35. Name the four compartments of the cranial cavity
    • Cells- neurons, glia, tumors, extravasated blood
    • Fluid- intracellular and extracellular
    • CSF
    • Blood
  36. Which compartment do we have the most control during an anesthetic?
    Blood compartment
  37. What should your goal map be?
    Keep MAP at 10% within awake values
  38. Name the four pathways for herniation
    • 1. subfalcine
    • 2. uncal
    • 3. cerebellar
    • 4. transcalvarial
  39. What is the normal CBF?
    50 mg/100g/min
  40. What CBF is associated with failure and structural damage?
    < 20-25 ml/100g/min
  41. What vessels do TCD detect thru the temporal bone window?
    Anterior cerebral, anterior communicating, posterior cerebral, posterior communicating, middle cerebral
  42. What vessels do TCD detect thru the back of the flexed neck?
    Basilar, opthalmic, internal carotids
  43. EEG monitoring definition
    surface recordings of summation of excitation and inhibitory post synaptic potentials generated by pyramidal cells in the cerebral cortex
  44. Amplitude
    Size or voltage of signal
  45. frequency
    number of times signal oscillates
  46. Time
    duration of the sampling of the eeg signal
  47. Beta waves
    13-30 Hz

    Parietally and frontally
  48. Alpha waves
    8-13 Hz

  49. Theta waves
    4-8 Hz

    Children, sleeping adults
  50. Delta waves
    0.5-4 Hz

    Infants, sleeping adults
  51. Epilepsy on EEG shows up like:
    high voltage spikes with slow waves
  52. Ischemia shows up like this on EEG
    slowing frequency with preservation amplitude of loss of amplitude (severe)
  53. Gold standard for intra-op EEG monitoring
    continuous visual inspection of a 16-32 channel analog EEG by experienced electroencephalographer
  54. 0.3 MAC does this to the EEG
    increases frontal beta activity

    low voltage, high frequency
  55. 0.5 MAC does this to the EEG
    Larger voltage, slower frequency
  56. 1 MAC does this to the EEG
    irregular slow activity
  57. 1.25 MAC does this to the eeg
    alternating activity
  58. Very deep anesthesia 1.6 MAC does this to EEG
    Burst suppression, eventually isoelectric
  59. How does isoflurane alter the EEG?
    burst suppression is easily acheivable
  60. 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
  61. epileptiform definition
    tonic clonic movements that are not necessarily a seizure.

    Can be caused by brevital or etomidate
  62. Which IV anesthetic agents can cause EEG suppression?
    barbituates, propofol, and etomidate
  63. Name non-anesthetic factors affecting EEG
    • CABG
    • occlusion of major cerebral vessel
    • Hypoxemia
    • hypercarbia
    • hypotension
    • hypothermia
    • hypocarbia
    • surgically induced emboli to the brain
    • retraction on cerebral cortex
  64. latency
    time from stimulus to onset of sensory evoked potential
  65. Which tract do sensory evoked potentials run on?
    • spinothalamic
    • sensory
    • dorsal column
  66. Name the three types of sensory evoked potentials?
    • Somatosensory (SSEP)
    • Auditory (BAEP)

    Visual (VEP)