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Questions and Answers
in cases of focal ischemia, anesthesia is considered being ?
in cases of focal ischemia, anesthesia is considered being ?
- harmful
- has no clinical effect
- undefined
- protective (correct)
Which mechanism is attributed as the principal reason for the protective efficacy of barbiturates in focal cerebral ischemia?
Which mechanism is attributed as the principal reason for the protective efficacy of barbiturates in focal cerebral ischemia?
- Increase in free radicals
- Suppression of CMR (correct)
- Promotion of CBF redistribution
- Enhancement of CMR
What role does CMR suppression play in brain regions affected by focal ischemia?
What role does CMR suppression play in brain regions affected by focal ischemia?
- Leads to flat EEG readings
- benefit to brain regions in which oxygen delivery is inadequate (correct)
- Increases oxygen consumption
- Induces abnormal EEG patterns
What is an expected benefit of CMR suppression in areas affected by focal ischemia?
What is an expected benefit of CMR suppression in areas affected by focal ischemia?
Why should readers be cautious when reviewing the protection-by-anesthetics literature?
Why should readers be cautious when reviewing the protection-by-anesthetics literature?
What is the primary concern raised regarding the experiments involving barbiturates and temperature control?
What is the primary concern raised regarding the experiments involving barbiturates and temperature control?
When should barbiturate-induced EEG suppression be considered as a logical therapy?
When should barbiturate-induced EEG suppression be considered as a logical therapy?
Why have barbiturates traditionally been administered to produce maximal reduction of the CMR?
Why have barbiturates traditionally been administered to produce maximal reduction of the CMR?
What raises the important issue of equivalence among various barbiturates in terms of their protective efficacy?
What raises the important issue of equivalence among various barbiturates in terms of their protective efficacy?
In what scenario did methohexital and thiopental demonstrate a similar reduction in injury?
In what scenario did methohexital and thiopental demonstrate a similar reduction in injury?
What is the proposed neuroprotective mechanism of action for xenon?
What is the proposed neuroprotective mechanism of action for xenon?
Which statement accurately reflects the comparison between different volatile anesthetics regarding their neuroprotective efficacy?
Which statement accurately reflects the comparison between different volatile anesthetics regarding their neuroprotective efficacy?
What is suggested by the available data regarding anesthesia and its protective effect compared to the awake state?
What is suggested by the available data regarding anesthesia and its protective effect compared to the awake state?
isoflurane is considered ?
isoflurane is considered ?
Which type of ischemia models has shown isoflurane to be neuroprotective?
Which type of ischemia models has shown isoflurane to be neuroprotective?
What observation was made about the sustainability of isoflurane's neuroprotective efficacy in a preclinical investigation?
What observation was made about the sustainability of isoflurane's neuroprotective efficacy in a preclinical investigation?
In what circumstances has sevoflurane been found to reduce ischemic injury in animal models?
In what circumstances has sevoflurane been found to reduce ischemic injury in animal models?
What has research shown regarding the impact of propofol on cerebral infarction in comparison with awake animals?
What has research shown regarding the impact of propofol on cerebral infarction in comparison with awake animals?
In direct comparison to pentobarbital, what similarity in cerebral injury was observed with propofol after focal ischemia in animals?
In direct comparison to pentobarbital, what similarity in cerebral injury was observed with propofol after focal ischemia in animals?
What observation was made regarding the protective efficacy of etomidate in an experimental model of focal ischemia?
What observation was made regarding the protective efficacy of etomidate in an experimental model of focal ischemia?
In patients subjected to temporary intracranial vessel occlusion, what effect does the administration of etomidate have on tissue hypoxia and acidosis compared to equivalent desflurane anesthesia?
In patients subjected to temporary intracranial vessel occlusion, what effect does the administration of etomidate have on tissue hypoxia and acidosis compared to equivalent desflurane anesthesia?
How does propofol protection compare to volatile anesthetics based on initial investigations?
How does propofol protection compare to volatile anesthetics based on initial investigations?
Which calcium channel antagonist is established for clinical use after subarachnoid hemorrhage (SAH)?
Which calcium channel antagonist is established for clinical use after subarachnoid hemorrhage (SAH)?
What is the proposed mode of action for the neuroprotective effect of nimodipine after SAH?
What is the proposed mode of action for the neuroprotective effect of nimodipine after SAH?
Which statement is true about the use of calcium channel blockers (CCBs) after neurologic stroke?
Which statement is true about the use of calcium channel blockers (CCBs) after neurologic stroke?
What is the recommended use of CCBs in the management of blood pressure?
What is the recommended use of CCBs in the management of blood pressure?
What is the recommended range for maintaining the mean arterial pressure (MAP) in most patients with cerebral ischemia?
What is the recommended range for maintaining the mean arterial pressure (MAP) in most patients with cerebral ischemia?
What effect does a reduction in blood pressure of 10% to 20% have on patients with acute stroke who are treated with nimodipine?
What effect does a reduction in blood pressure of 10% to 20% have on patients with acute stroke who are treated with nimodipine?
In patients treated with thrombolytic agents for stroke, what is the recommended blood pressure range to reduce the incidence of hemorrhage into the ischemic brain?
In patients treated with thrombolytic agents for stroke, what is the recommended blood pressure range to reduce the incidence of hemorrhage into the ischemic brain?
What effect does hypotension have on cerebral blood flow (CBF) in patients with cerebral ischemia?
What effect does hypotension have on cerebral blood flow (CBF) in patients with cerebral ischemia?
What is the proposed mechanism of action for the adverse impact of blood pressure reduction on an injured brain in patients with cerebral ischemia?
What is the proposed mechanism of action for the adverse impact of blood pressure reduction on an injured brain in patients with cerebral ischemia?
What is the target MAP for patients with cerebral ischemia, based on preexisting blood pressure?
What is the target MAP for patients with cerebral ischemia, based on preexisting blood pressure?
What is the recommended blood pressure augmentation for patients with SAH-induced vasospasm?
What is the recommended blood pressure augmentation for patients with SAH-induced vasospasm?
What is the recommended CPP range for patients with traumatic brain injury?
What is the recommended CPP range for patients with traumatic brain injury?
What is the primary goal of blood pressure augmentation in patients with SAH-induced vasospasm and traumatic brain injury?
What is the primary goal of blood pressure augmentation in patients with SAH-induced vasospasm and traumatic brain injury?
What is the recommended systolic BP in patients with SAH-induced vasospasm ?
What is the recommended systolic BP in patients with SAH-induced vasospasm ?
What is the recommended CPP in patients with traumatic brain injury?
What is the recommended CPP in patients with traumatic brain injury?
What is the impact of hypocapnia on intracerebral perfusion?
What is the impact of hypocapnia on intracerebral perfusion?
What is the recommended practice regarding the manipulation of Paco2 in the absence of a means to verify perfusion response?
What is the recommended practice regarding the manipulation of Paco2 in the absence of a means to verify perfusion response?
What is the potential consequence of hypercapnia on intracerebral perfusion?
What is the potential consequence of hypercapnia on intracerebral perfusion?
What is the relevance of the 'Robin Hood' or inverse steal effect in the context of Paco2 manipulation?
What is the relevance of the 'Robin Hood' or inverse steal effect in the context of Paco2 manipulation?
What is the primary cerebral protective technique for circulatory arrest procedures?
What is the primary cerebral protective technique for circulatory arrest procedures?
What effect does mild hypothermia have on electrophysiologic energy consumption and cellular integrity maintenance?
What effect does mild hypothermia have on electrophysiologic energy consumption and cellular integrity maintenance?
What benefit is associated with hypothermia initiation in the immediate postischemic period?
What benefit is associated with hypothermia initiation in the immediate postischemic period?
What advantage of hypothermia use in the surgical setting is highlighted by its proponents?
What advantage of hypothermia use in the surgical setting is highlighted by its proponents?
What was observed in hypothermic patients undergoing intracranial aneurysm clipping based on pilot study results?
What was observed in hypothermic patients undergoing intracranial aneurysm clipping based on pilot study results?
hypothermia is not recommended for neuroprotection in ?
hypothermia is not recommended for neuroprotection in ?
What do recent trials indicate about the induction of hypothermia after successful resuscitation from cardiac arrest?
What do recent trials indicate about the induction of hypothermia after successful resuscitation from cardiac arrest?
Why is avoiding hyperthermia crucial in patients at risk of cerebral ischemia?
Why is avoiding hyperthermia crucial in patients at risk of cerebral ischemia?
What effect can a 1°C increase in body temperature have on ischemic injury?
What effect can a 1°C increase in body temperature have on ischemic injury?
What is a common complication associated with induced hypothermia in stroke patients?
What is a common complication associated with induced hypothermia in stroke patients?
What side effects are frequently associated with induced hypothermia in stroke patients?
What side effects are frequently associated with induced hypothermia in stroke patients?
What is the rationale behind withholding glucose-containing solutions in situations where cerebral ischemia may occur?
What is the rationale behind withholding glucose-containing solutions in situations where cerebral ischemia may occur?
What did the results of the randomized clinical trial on insulin administration to stroke patients show?
What did the results of the randomized clinical trial on insulin administration to stroke patients show?
What has long-term outcome studies shown about the impact of hyperglycemia on patients with stroke?
What has long-term outcome studies shown about the impact of hyperglycemia on patients with stroke?
What is the recommended range for maintaining blood glucose levels in clinical settings?
What is the recommended range for maintaining blood glucose levels in clinical settings?
At what blood glucose level is suppression of the EEG observed?
At what blood glucose level is suppression of the EEG observed?
What happens to CMR and CBF during sustained seizure activity?
What happens to CMR and CBF during sustained seizure activity?
What is a significant consequence of hypoglycemia with a level of 20 mg/dL or lower?
What is a significant consequence of hypoglycemia with a level of 20 mg/dL or lower?
What effect does a shift in EEG frequencies toward delta and theta have on cerebral injury?
What effect does a shift in EEG frequencies toward delta and theta have on cerebral injury?
What is the current practice regarding hemodilution in patients with ischemia associated with vasospasm in SAH?
What is the current practice regarding hemodilution in patients with ischemia associated with vasospasm in SAH?
What is the recommended approach for a procedure where incomplete ischemia might occur, such as CEA, with respect to hematocrit?
What is the recommended approach for a procedure where incomplete ischemia might occur, such as CEA, with respect to hematocrit?
What is the impact of increased hematocrit on cerebral blood flow (CBF) due to viscosity effects?
What is the impact of increased hematocrit on cerebral blood flow (CBF) due to viscosity effects?
What is the theoretic optimal hematocrit for patients in whom focal ischemia might occur in the surgical unit?
What is the theoretic optimal hematocrit for patients in whom focal ischemia might occur in the surgical unit?
What is the threshold Pao2 that leads to an increase in mortality in patients who have sustained cardiac arrest?
What is the threshold Pao2 that leads to an increase in mortality in patients who have sustained cardiac arrest?
In which situation does hyperoxia improve cerebral metabolism?
In which situation does hyperoxia improve cerebral metabolism?
What is the potential adverse effect of hyperoxia in the injured brain?
What is the potential adverse effect of hyperoxia in the injured brain?
What is the potential consequence of excessive Pao2 (>487 mm Hg) in hyperoxic patients?
What is the potential consequence of excessive Pao2 (>487 mm Hg) in hyperoxic patients?
What is the recommended Pao2 range to avoid increased mortality in patients who have sustained cardiac arrest?
What is the recommended Pao2 range to avoid increased mortality in patients who have sustained cardiac arrest?
Which anesthetics have been found to potentially reduce ischemic injury?
Which anesthetics have been found to potentially reduce ischemic injury?
What is the recommended practice regarding the use of a specific anesthetic for the purpose of brain protection in the clinical setting?
What is the recommended practice regarding the use of a specific anesthetic for the purpose of brain protection in the clinical setting?
What should efforts for brain protection primarily focus on?
What should efforts for brain protection primarily focus on?
What is the recommended delay before performing Carotid Endarterectomy (CEA) after a stroke?
What is the recommended delay before performing Carotid Endarterectomy (CEA) after a stroke?
How long does it take for regional CBF and CMR to stabilize after a stroke?
How long does it take for regional CBF and CMR to stabilize after a stroke?
When do BBB abnormalities, as reflected by the accumulation of CT contrast material or brain scan isotopes, resolve after a stroke?
When do BBB abnormalities, as reflected by the accumulation of CT contrast material or brain scan isotopes, resolve after a stroke?
What is the primary risk associated with delaying carotid endarterectomy (CEA) after a stroke?
What is the primary risk associated with delaying carotid endarterectomy (CEA) after a stroke?
In which group of stroke patients is early CEA generally preferable?
In which group of stroke patients is early CEA generally preferable?
What is the risk of intracerebral hemorrhage when performing early CEA after stroke?
What is the risk of intracerebral hemorrhage when performing early CEA after stroke?
When does the occurrence of adverse cardiovascular events, including new stroke and myocardial infarction, stabilize after a stroke?
When does the occurrence of adverse cardiovascular events, including new stroke and myocardial infarction, stabilize after a stroke?
What is a key factor that should be considered when deciding on the timing of CEA after a stroke?
What is a key factor that should be considered when deciding on the timing of CEA after a stroke?
What type of patients may be candidates for early CEA after a stroke?
What type of patients may be candidates for early CEA after a stroke?
What percentage of patients with stroke experience loss of normal vasomotor responses beyond 2 weeks?
What percentage of patients with stroke experience loss of normal vasomotor responses beyond 2 weeks?
What is an important consideration for deferring elective surgery after a cerebral vascular accident, extrapolating from CEA studies?
What is an important consideration for deferring elective surgery after a cerebral vascular accident, extrapolating from CEA studies?
In patients who have sustained a stroke, the incidence of a second stroke is approximately ?
In patients who have sustained a stroke, the incidence of a second stroke is approximately ?
What was observed in humans regarding the restoration of LLA with antihypertensive therapy?
What was observed in humans regarding the restoration of LLA with antihypertensive therapy?
What is a suggested unexplored possibility about the restoration of LLA with antihypertensive therapy?
What is a suggested unexplored possibility about the restoration of LLA with antihypertensive therapy?
What effect have ACE inhibitors been shown to have on the LLA in both normotensive and hypertensive subjects?
What effect have ACE inhibitors been shown to have on the LLA in both normotensive and hypertensive subjects?
What is the recommended limit for elective MAP reduction in both hypertensive and normotensive patients for cerebral well-being?
What is the recommended limit for elective MAP reduction in both hypertensive and normotensive patients for cerebral well-being?
What is the average reduction in MAP that brings both normotensive and hypertensive patients to the LLA?
What is the average reduction in MAP that brings both normotensive and hypertensive patients to the LLA?
What happens to CBF values as the reduction in the MAP exceeds 25% of baseline?
What happens to CBF values as the reduction in the MAP exceeds 25% of baseline?
What is the impact of a 50% reduction in MAP in nonanesthetized patients?
What is the impact of a 50% reduction in MAP in nonanesthetized patients?
What type of edema is often associated with intracranial tumors?
What type of edema is often associated with intracranial tumors?
What is the relationship between cerebral blood flow (CBF) and propofol in regions of the brain surrounding the tumor?
What is the relationship between cerebral blood flow (CBF) and propofol in regions of the brain surrounding the tumor?
What is the impact of changes in Pao2 and Paco2 on vascular responsiveness in patients with gliomas?
What is the impact of changes in Pao2 and Paco2 on vascular responsiveness in patients with gliomas?
Which statement is true regarding the measurement of regional CBF in the area of the tumor?
Which statement is true regarding the measurement of regional CBF in the area of the tumor?
What is the primary cause of edema formation in the peritumoral region?
What is the primary cause of edema formation in the peritumoral region?
What is the effect of intracranial tumors on cerebral blood flow (CBF) compared to the normal brain?
What is the effect of intracranial tumors on cerebral blood flow (CBF) compared to the normal brain?
What is the primary cause of rebound edema formation with mannitol osmotherapy?
What is the primary cause of rebound edema formation with mannitol osmotherapy?
What is the main effect of dexamethasone treatment on tumor edema?
What is the main effect of dexamethasone treatment on tumor edema?
What is the role of loop diuretics such as bumetanide in reducing rebound edema?
What is the role of loop diuretics such as bumetanide in reducing rebound edema?
What factors contribute to the formation of tumor edema?
What factors contribute to the formation of tumor edema?
How does mannitol osmotherapy affect the reduction of intracerebral pressure (ICP) in the surgical unit?
How does mannitol osmotherapy affect the reduction of intracerebral pressure (ICP) in the surgical unit?
What physiological adjustment is seen in the CMR during lesions in the reticular activating system?
What physiological adjustment is seen in the CMR during lesions in the reticular activating system?
What occurs to cerebral acidosis during prolonged generalized seizure activity?
What occurs to cerebral acidosis during prolonged generalized seizure activity?
How can the development of irreversible neuronal damage be prevented during prolonged seizures?
How can the development of irreversible neuronal damage be prevented during prolonged seizures?
What is the primary goal of therapy aimed at interrupting seizures?
What is the primary goal of therapy aimed at interrupting seizures?
Which measures are considered important adjuncts during intensive motor and brain activity associated with generalized seizures?
Which measures are considered important adjuncts during intensive motor and brain activity associated with generalized seizures?
What is the recommended class of medications for interrupting seizures and restoring balance between cerebral metabolic demand and blood flow?
What is the recommended class of medications for interrupting seizures and restoring balance between cerebral metabolic demand and blood flow?
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