Podcast
Questions and Answers
What systemic complication is most commonly associated with decreased intravascular volume in patients with SAH?
What systemic complication is most commonly associated with decreased intravascular volume in patients with SAH?
- Thrombocytopenia
- Bleeding (correct)
- Hepatic dysfunction
- Heart failure
Which type of cerebral aneurysm is characterized by twisting vascular channels with an entry and exit point
Which type of cerebral aneurysm is characterized by twisting vascular channels with an entry and exit point
- Fusiform aneurysm
- Saccular aneurysm
- Serpentine aneurysm (correct)
- Mycotic aneurysm
In patients with SAH, which alteration is commonly observed that involves cardiac changes? select all that apply
In patients with SAH, which alteration is commonly observed that involves cardiac changes? select all that apply
- Atrial fibrillation
- ST elevation and depression (correct)
- T wave abnormalities (correct)
- U and Q waves (correct)
What percentage of patients may experience hepatic dysfunction following a subarachnoid hemorrhage?
What percentage of patients may experience hepatic dysfunction following a subarachnoid hemorrhage?
Where are the majority of cerebral aneurysms typically located?
Where are the majority of cerebral aneurysms typically located?
What primary function does the Windkessel effect serve in the cardiovascular system?
What primary function does the Windkessel effect serve in the cardiovascular system?
Which condition is most likely to contribute to the formation of cerebral aneurysms?
Which condition is most likely to contribute to the formation of cerebral aneurysms?
How does the Windkessel effect help mitigate the risks associated with cerebral aneurysms?
How does the Windkessel effect help mitigate the risks associated with cerebral aneurysms?
What are characteristic symptoms of SAH?
What are characteristic symptoms of SAH?
Which of the following are considered risk factors for subarachnoid hemorrhage?
Which of the following are considered risk factors for subarachnoid hemorrhage?
What happens in the vascular system when there is a loss of arterial elasticity due to conditions like aneurysms?
What happens in the vascular system when there is a loss of arterial elasticity due to conditions like aneurysms?
What condition can increase arterial oscillations, potentially affecting aneurysms?
What condition can increase arterial oscillations, potentially affecting aneurysms?
Which statement accurately describes the influence of the aneurysmal pouch in larger cerebral aneurysms?
Which statement accurately describes the influence of the aneurysmal pouch in larger cerebral aneurysms?
What is the highest risk period for rebleeding after a SAH?
What is the highest risk period for rebleeding after a SAH?
How does Nimodipine function in the treatment of SAH?
How does Nimodipine function in the treatment of SAH?
What type of intervention is used to prevent rebleeding and often requires critical timing 24-48 hr after SAH?
What type of intervention is used to prevent rebleeding and often requires critical timing 24-48 hr after SAH?
In the context of treating vasospasm after SAH, what is Triple H therapy?
In the context of treating vasospasm after SAH, what is Triple H therapy?
What is the goal of aneurysm coiling and clipping during surgical intervention?
What is the goal of aneurysm coiling and clipping during surgical intervention?
What is a potential complication of using flow diverting stents for unruptured aneurysms?
What is a potential complication of using flow diverting stents for unruptured aneurysms?
Symptoms of aneurysm rupture during induction may include which of the following?
Symptoms of aneurysm rupture during induction may include which of the following?
What is the target mean arterial pressure (MAP) to be achieved after aneurysm rupture for permissive hypotension?
What is the target mean arterial pressure (MAP) to be achieved after aneurysm rupture for permissive hypotension?
Which medications must be readily available in the operating room for managing increased intracranial pressure? select all that apply
Which medications must be readily available in the operating room for managing increased intracranial pressure? select all that apply
What is the purpose of using a temporary proximal occlusion clamp during surgery?
What is the purpose of using a temporary proximal occlusion clamp during surgery?
What are the signs of venous air embolism (VAE) that you should monitor for during surgery?
What are the signs of venous air embolism (VAE) that you should monitor for during surgery?
What initial actions should be taken simultaneously when a venous air embolism (VAE) occurs?
What initial actions should be taken simultaneously when a venous air embolism (VAE) occurs?
What positioning consideration is important when preparing for an aneurysm clipping surgery?
What positioning consideration is important when preparing for an aneurysm clipping surgery?
What should the intraoperative monitoring for paradoxic air embolism (PAE) include? select 2
What should the intraoperative monitoring for paradoxic air embolism (PAE) include? select 2
How does the Windkessel effect contribute to maintaining blood flow in smaller vessels?
How does the Windkessel effect contribute to maintaining blood flow in smaller vessels?
What happens if a vessel wall is weakened, such as in an aneurysm, in relation to the Windkessel effect?
What happens if a vessel wall is weakened, such as in an aneurysm, in relation to the Windkessel effect?
Why does the weakening of a vessel wall increase the risk of aneurysm rupture?
Why does the weakening of a vessel wall increase the risk of aneurysm rupture?
What is arterial elasticity, also called arterial compliance?
What is arterial elasticity, also called arterial compliance?
In larger aneurysms, the pouch serves as a ___ in systole and is released in diastole.
In larger aneurysms, the pouch serves as a ___ in systole and is released in diastole.
What is the incidence of spontaneous subarachnoid hemorrhage (SAH) per 100,000 people?
What is the incidence of spontaneous subarachnoid hemorrhage (SAH) per 100,000 people?
What is the primary cause of subarachnoid hemorrhage (SAH)?
What is the primary cause of subarachnoid hemorrhage (SAH)?
What happens in the body when a subarachnoid hemorrhage (SAH) occurs? (Select all that apply)
What happens in the body when a subarachnoid hemorrhage (SAH) occurs? (Select all that apply)
Which of the following cellular changes are associated with subarachnoid hemorrhage (SAH)?
Which of the following cellular changes are associated with subarachnoid hemorrhage (SAH)?
Which of the following genetic risk factors is associated with subarachnoid hemorrhage (SAH)? select 3
Which of the following genetic risk factors is associated with subarachnoid hemorrhage (SAH)? select 3
Which electrolyte abnormalities are associated with subarachnoid hemorrhage (SAH)?
Which electrolyte abnormalities are associated with subarachnoid hemorrhage (SAH)?
When do peak systemic symptoms occur in subarachnoid hemorrhage (SAH)?
When do peak systemic symptoms occur in subarachnoid hemorrhage (SAH)?
What is the cause of systemic complications in subarachnoid hemorrhage (SAH)?
What is the cause of systemic complications in subarachnoid hemorrhage (SAH)?
Which systemic complications from subarachnoid hemorrhage (SAH) are associated with sepsis? select 2
Which systemic complications from subarachnoid hemorrhage (SAH) are associated with sepsis? select 2
Match the following aneurysm types with their descriptions:
Match the following aneurysm types with their descriptions:
What is the cause of mycotic aneurysms?
What is the cause of mycotic aneurysms?
What are Dolichoectatic aneurysms characterized by?
What are Dolichoectatic aneurysms characterized by?
Where are aneurysms typically located in females?
Where are aneurysms typically located in females?
Where are aneurysms typically located in males?
Where are aneurysms typically located in males?
Where are aneurysms typically located in children?
Where are aneurysms typically located in children?
What are higher scores in cerebral aneurysm grading associated with?
What are higher scores in cerebral aneurysm grading associated with?
How does the Hunt and Hess grading scale classify aneurysms based on clinical signs and symptoms? select all that apply
How does the Hunt and Hess grading scale classify aneurysms based on clinical signs and symptoms? select all that apply
How does the World Federation of Neurological Surgeons scale classify aneurysms?
How does the World Federation of Neurological Surgeons scale classify aneurysms?
How does the risk of rebleeding change over time in subarachnoid hemorrhage (SAH)?
How does the risk of rebleeding change over time in subarachnoid hemorrhage (SAH)?
What is the primary cause of vasospasm following a subarachnoid hemorrhage (SAH)?
What is the primary cause of vasospasm following a subarachnoid hemorrhage (SAH)?
When does the risk of vasospasm occur and peak after a subarachnoid hemorrhage?
When does the risk of vasospasm occur and peak after a subarachnoid hemorrhage?
When does the risk of vasospasm typically resolve after a subarachnoid hemorrhage (SAH)?
When does the risk of vasospasm typically resolve after a subarachnoid hemorrhage (SAH)?
What percentage of patients are at risk of vasospasm following a subarachnoid hemorrhage?
What percentage of patients are at risk of vasospasm following a subarachnoid hemorrhage?
What is the result of impaired autoregulation?
What is the result of impaired autoregulation?
What is unique about CO2 reactivity in patients with subarachnoid hemorrhage (SAH)?
What is unique about CO2 reactivity in patients with subarachnoid hemorrhage (SAH)?
Why does hydrocephalus occur in subarachnoid hemorrhage (SAH)?
Why does hydrocephalus occur in subarachnoid hemorrhage (SAH)?
What are the surgical options for managing rebleeding? (Select all that apply)
What are the surgical options for managing rebleeding? (Select all that apply)
What are the treatment options for vasospasm? (Select all that apply)
What are the treatment options for vasospasm? (Select all that apply)
When should nimodipine be started after a subarachnoid hemorrhage (SAH)?
When should nimodipine be started after a subarachnoid hemorrhage (SAH)?
What is the mechanism of action of nimodipine?
What is the mechanism of action of nimodipine?
What is a contraindication to aneurysm coiling?
What is a contraindication to aneurysm coiling?
When should aneurysm clipping occur?
When should aneurysm clipping occur?
What approach is commonly used in aneurysm coiling?
What approach is commonly used in aneurysm coiling?
How is the aneurysm accessed for clip ligation?
How is the aneurysm accessed for clip ligation?
How do flow-diverting stents treat aneurysms?
How do flow-diverting stents treat aneurysms?
What is unique about flow diverting stents in the treatment of aneurysms?
What is unique about flow diverting stents in the treatment of aneurysms?
What should be part of your setup for general anesthesia in treating an aneurysm?
What should be part of your setup for general anesthesia in treating an aneurysm?
When using permissive hypotension to treat a ruptured aneurysm, when should the blood pressure goal return to normal?
When using permissive hypotension to treat a ruptured aneurysm, when should the blood pressure goal return to normal?
What should blood loss be replaced with in the event of an aneurysmal rupture?
What should blood loss be replaced with in the event of an aneurysmal rupture?
What is the purpose of a temporary proximal occlusion clamp?
What is the purpose of a temporary proximal occlusion clamp?
How long does the temporary proximal occlusion clamp provide its effects?
How long does the temporary proximal occlusion clamp provide its effects?
What is the purpose of a lumbar drain?
What is the purpose of a lumbar drain?
How are giant aneurysms managed differently from other aneurysms? Select the correct options.
How are giant aneurysms managed differently from other aneurysms? Select the correct options.
What are characteristics of brain tumors in adults?
What are characteristics of brain tumors in adults?
Where are brain tumors typically found in children?
Where are brain tumors typically found in children?
What is the most common cause of delayed awakening in the sitting position?
What is the most common cause of delayed awakening in the sitting position?
What is tension pneumocephalus?
What is tension pneumocephalus?
Intraoperative management for brain tumors is similar to that of intracranial aneurysms
Intraoperative management for brain tumors is similar to that of intracranial aneurysms
Flat ToF desired in the anesthetic care of aneurysms and brain tumors
Flat ToF desired in the anesthetic care of aneurysms and brain tumors
Where is the posterior fossa located?
Where is the posterior fossa located?
What does the posterior fossa contain?
What does the posterior fossa contain?
Why is hydrocephalus associated with posterior fossa tumors?
Why is hydrocephalus associated with posterior fossa tumors?
What symptoms are associated with posterior fossa tumors? (Select all that apply)
What symptoms are associated with posterior fossa tumors? (Select all that apply)
Which nerves are most at risk of compression from posterior fossa tumors?
Which nerves are most at risk of compression from posterior fossa tumors?
How does the management of posterior fossa tumors differ from tumors located in the supratentorial region?
How does the management of posterior fossa tumors differ from tumors located in the supratentorial region?
What type of surgery has a high incidence of venous air embolism (VAE)?
What type of surgery has a high incidence of venous air embolism (VAE)?
Why do we use precordial Dopplers in the sitting position?
Why do we use precordial Dopplers in the sitting position?
Why does decreased ETCO2 but increased PaCO2 occur in Venous Air Embolism (VAE)?
Why does decreased ETCO2 but increased PaCO2 occur in Venous Air Embolism (VAE)?
What occurs to the ETCO2 and PaCO2 in VAE? (Select the correct answer)
What occurs to the ETCO2 and PaCO2 in VAE? (Select the correct answer)
What gas can appear in exhaled gas on the gas analyzer in the case of Venous Air Embolism (VAE)?
What gas can appear in exhaled gas on the gas analyzer in the case of Venous Air Embolism (VAE)?
What is the effect on the heart in venous air embolism (VAE)?
What is the effect on the heart in venous air embolism (VAE)?
What is the result on the heart of untreated VAE? (Select the correct answer)
What is the result on the heart of untreated VAE? (Select the correct answer)
How can we prevent venous air embolism (VAE) using mechanical ventilation? select 2
How can we prevent venous air embolism (VAE) using mechanical ventilation? select 2
What is a consequence of increased PEEP in mechanical ventilation?
What is a consequence of increased PEEP in mechanical ventilation?
What are the risk factors for developing a paradoxical artery embolism (PAE)?
What are the risk factors for developing a paradoxical artery embolism (PAE)?
What causes a paradoxical air embolism (PAE)?
What causes a paradoxical air embolism (PAE)?
what are the steps to treatment of VAE?
what are the steps to treatment of VAE?
Flashcards
SAH Systemic Complications
SAH Systemic Complications
Subarachnoid hemorrhage (SAH) can cause decreased blood volume, electrolyte imbalances (like low sodium, potassium, and calcium), and heart problems (like unusual ECG patterns). It can also impact the lungs, liver, kidneys, and blood platelets.
Cerebral Aneurysm Types
Cerebral Aneurysm Types
Cerebral aneurysms come in different forms: saccular (bulging), fusiform (widening), dissecting (tearing), traumatic, mycotic (infected), and dolichoectatic (chronic widening).
Cerebral Aneurysm Location
Cerebral Aneurysm Location
Most cerebral aneurysms (about 90%) are in the front part of the brain (anterior circulation), with the rest in the back (posterior circulation).
Acute Global Ischemia Cause
Acute Global Ischemia Cause
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SAH Peak Symptoms Time
SAH Peak Symptoms Time
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Windkessel effect
Windkessel effect
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Arterial elasticity
Arterial elasticity
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Cerebral aneurysm
Cerebral aneurysm
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Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH)
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Risk factors of SAH
Risk factors of SAH
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SAH symptoms
SAH symptoms
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Windkessel effect and aneurysms
Windkessel effect and aneurysms
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Conditions increasing arterial oscillations
Conditions increasing arterial oscillations
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Permissive Hypotension
Permissive Hypotension
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VAE Signs
VAE Signs
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VAE Prevention
VAE Prevention
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VAE Treatment (Initial Steps)
VAE Treatment (Initial Steps)
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PAE (Paradoxic Air Embolism)
PAE (Paradoxic Air Embolism)
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TEE for PAE
TEE for PAE
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Temporary Proximal Occlusion Clamp
Temporary Proximal Occlusion Clamp
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Positioning Considerations
Positioning Considerations
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Hunt & Hess Grading System
Hunt & Hess Grading System
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World Federation of Neurological Surgeons (WFNS) Scale
World Federation of Neurological Surgeons (WFNS) Scale
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Rebleeding after SAH
Rebleeding after SAH
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Vasospasm after SAH
Vasospasm after SAH
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Impaired Autoregulation after SAH
Impaired Autoregulation after SAH
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Nimodipine for SAH
Nimodipine for SAH
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Triple H Therapy for SAH
Triple H Therapy for SAH
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Aneurysm Clip Ligation
Aneurysm Clip Ligation
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Aneurysm Coiling
Aneurysm Coiling
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Aneurysm Rupture on Induction
Aneurysm Rupture on Induction
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Study Notes
Brain Tumors & Aneurysms
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Windkessel Effect: A phenomenon where large, elastic arteries dampen pulsatile blood flow from the heart, allowing smoother flow in smaller vessels. Passive vessel wall contraction helps maintain constant pressure. Weakened vessel walls (like in aneurysms) can't absorb pulsatile pressure, contributing to growth and rupture risk.
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Arterial Elasticity (Compliance): The ability of arteries to expand and contract with each heartbeat. Loss of elasticity in cerebral arteries contributes to aneurysm formation.
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Windkessel Effect in Cerebral Aneurysms: The effect helps prevent hemorrhage by keeping pressure inside the vessels constant, acting as a reservoir in systole and releasing blood in diastole.
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Conditions Increasing Arterial Oscillations: include dehydration, hemorrhage, and upright posture.
Subarachnoid Hemorrhage (SAH)
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Definition: Arterial bleeding from the space between the arachnoid and pia mater of the brain, usually caused by a ruptured cerebral aneurysm.
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Incidence: Information on specific incidence rates isn't included here.
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Presentation: The worst headache of one's life, accompanied by signs and symptoms of increased intracranial pressure (ICP).
Risk Factors for SAH
- Smoking, HTN, birth control pills, Marfan syndrome, and primordial/Ehlers Danlos are included.
Complications of SAH
- Rebleeding: Highest risk within the first 24 hours, declining to 1-2% per day after that.
- Vasospasm: Reactive narrowing of larger vessels, typically peaking 6-8 days after the event, potentially lasting 3 weeks.
- Other: Cardiogenic/neurogenic pulmonary edema, hepatic dysfunction, ARDS, pneumonia, sepsis, renal issues, and thrombocytopenia (low platelets) can occur.
- Impaired autoregulation: Leads to oxidative stress & release of free radicals.
- Intracranial pressure (ICP) increase: A consequence of blood in the subarachnoid space.
Surgical Management
- Embolization: Closing off vessels via coils or clipping.
- Clipping/Ligation: Surgical ligation (tying off) and clipping of aneurysms, typically within 24-48 hours. Coiling is an alternative technique performed under fluoroscopy. Femoral artery access can be utilized.
Brain Tumors
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Location (Adults): Primarily supratentorial spaces (above the tentorium cerebelli).
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Location (Children): Primarily infratentorial spaces (below the tentorium cerebelli).
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Symptoms: Associated with increased intracranial pressure (ICP).
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Positioning: Head of the bed (HOB) is turned to the left or right 90 degrees.
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Intraoperative Management: Similar to intracranial aneurysms, with concerns for tension pneumocephalus. Temporary proximal occlusion clamps may be used, reducing aneurysm risk. Minimally invasive techniques (coiling, etc.) are used in some cases.
Posterior Fossa Tumors
- Location: Located in the posterior fossa, between the foramen magnum and tentorium cerebelli.
- Management: Requires specialized surgical approaches like midline, paramedian, or retromastoid incisions to access the tumor. Risk factors are significant and include 40-45% risk of posterior fossa surgery in the sitting position from cervical laminectomy. Air is slowly entrained with sitting positions.
- Symptoms: Hydrocephalus, laryngeal dysfunction, and irregular breathing are common.
Paradoxic Air Embolism (PAE)
- Definition: Air enters the arterial circulation.
- Risk Factors: Patent foramen ovale (PFO), and sitting position are common risk concerns for PAE.
- Management: Immediate action is needed, including: alert the surgeon, flood the surgical site with fluid via CVP, and remove any air from the venous system (CVP) using aspiration and positive pressure. FiO2 is often increased to 100%, with N20 discontinued.
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Description
Explore the critical concepts surrounding brain tumors and aneurysms. This quiz delves into the Windkessel effect, arterial elasticity, and the implications of these phenomena in cerebral aneurysms. Understand how these factors contribute to conditions such as subarachnoid hemorrhage and the risks associated with arterial health.
