Anesthesia for Neurologic Surgery and Neurointerventions

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Why does early aneurysm clipping reduce the incidence of medical complications?

It decreases the risk of hydrocephalus

It decreases the incidence of pneumonia (correct)

It reduces the need for bed rest

It increases the risk of deep vein thrombosis

Why may early intervention increase the risk of intraoperative aneurysmal rupture?

Because it allows less time for a clot to organize over the initial bleed site (correct)

Due to decreased brain edema in the early post-SAH period

Because it reduces the risk of hydrocephalus

Due to increased pressure in the subarachnoid space

What is a common consequence of blood contaminating the subarachnoid space after aneurysmal SAH?

Decreased intracranial pressure

Increased risk of ischemic stroke

High likelihood of meningitis

Development of hydrocephalus (correct)

Why is there a premium on techniques to reduce intracranial content volume?

To facilitate exposure and minimize retraction pressures during surgery Signup and view all the answers

What is a significant factor affecting patients scheduled for intracranial aneurysm clipping?

Elements of their critical care management in ICU Signup and view all the answers

Why is maintaining a patient on bed rest until day 14 common practice in early neurosurgery?

To prevent spasm risks in the early recovery period Signup and view all the answers

What is the reported effect of dobutamine on cerebral blood flow in ischemic territories?

Augments CBF in ischemic territories Signup and view all the answers

Which calcium-channel blocker is considered standard for the management of SAH?

Nimodipine Signup and view all the answers

What was the outcome of the multicenter trial evaluating nicardipine as an intravenous alternative to nimodipine?

Symptomatic vasospasm reduced, but no improvement in outcome Signup and view all the answers

Which pharmacologic therapy has shown improved mortality without improving outcomes in SAH patients?

Endothelin antagonist clazosentan Signup and view all the answers

What was the outcome of the larger RCT (STASH) related to statin administration in SAH patients?

Failed to demonstrate short-term or long-term outcome benefits Signup and view all the answers

What is the reported effect of cilostazol following SAH?

Reduction in symptomatic vasospasm and new cerebral infarctions Signup and view all the answers

What is the triad of symptoms associated with cerebral salt-wasting syndrome?

Hyponatremia, volume contraction, high urine sodium concentrations Signup and view all the answers

How is SIADH typically managed?

Fluid restriction Signup and view all the answers

What is the suspected cause of vasospasm after SAH?

Breakdown products of hemoglobin Signup and view all the answers

How is symptomatic vasospasm historically treated?

"Triple H" therapy (hypervolemia, hypertension, hemodilution) Signup and view all the answers

What are the components of "Triple H" therapy for vasospasm?

Hypervolemia, hypertension, hemodilution Signup and view all the answers

What should be avoided during surgery for patients with vasospasm?

Avoiding hypotension Signup and view all the answers

Which medication is commonly used for pressor support in patients with vasospasm?

Phenylephrine Signup and view all the answers

What is the primary objective of administering pressors in vasospasm patients?

Increase in mean arterial pressure Signup and view all the answers

What is the focus of current management for symptomatic vasospasm?

Maintenance of euvolemia and hypertension Signup and view all the answers