Podcast
Questions and Answers
Which induction agent is known to decrease cerebral perfusion pressure (CPP) due to its effects on reducing mean arterial pressure (MAP) and systemic vascular resistance (SVR)?
Which induction agent is known to decrease cerebral perfusion pressure (CPP) due to its effects on reducing mean arterial pressure (MAP) and systemic vascular resistance (SVR)?
- Ketamine
- Propofol (correct)
- Etomidate
- Phenylephrine
What common anesthetic agent is associated with increasing cerebral blood flow (CBF) despite decreasing cerebral metabolic rate for oxygen (CMRO2) i.e. uncoupling?
What common anesthetic agent is associated with increasing cerebral blood flow (CBF) despite decreasing cerebral metabolic rate for oxygen (CMRO2) i.e. uncoupling?
- Fentanyl
- Ketamine
- Volatile anesthetics (correct)
- Nitrous Oxide
Which neuromuscular blocker should be administered with a defasciculating dose to prevent an increase in intracranial pressure (ICP)?
Which neuromuscular blocker should be administered with a defasciculating dose to prevent an increase in intracranial pressure (ICP)?
- Succinylcholine (correct)
- Rocuronium
- Vecuronium
- Pancuronium
Why are steroids considered detrimental in the management of traumatic brain injury (TBI)?
Why are steroids considered detrimental in the management of traumatic brain injury (TBI)?
What is the preferred fluid type in TBI management to minimize the risk of cerebral edema?
What is the preferred fluid type in TBI management to minimize the risk of cerebral edema?
Which maintenance anesthetic agent poses a risk of elevating intracranial pressure (ICP) through increased CMRO2 and cerebral vasodilation?
Which maintenance anesthetic agent poses a risk of elevating intracranial pressure (ICP) through increased CMRO2 and cerebral vasodilation?
Why is the sitting position contraindicated in patients with a right-to-left intracardiac shunt?
Why is the sitting position contraindicated in patients with a right-to-left intracardiac shunt?
What is the target arterial CO2 level (PaCO2) during ventilation for TBI patients?
What is the target arterial CO2 level (PaCO2) during ventilation for TBI patients?
Which primary components are involved in the Monroe-Kellie Doctrine?
Which primary components are involved in the Monroe-Kellie Doctrine?
What occurs if there is an increase in one component of the cranial compartment without compensation?
What occurs if there is an increase in one component of the cranial compartment without compensation?
Which method is recognized as the gold standard for measuring intracranial pressure (ICP)?
Which method is recognized as the gold standard for measuring intracranial pressure (ICP)?
Where is cerebrospinal fluid (CSF) primarily produced in the body?
Where is cerebrospinal fluid (CSF) primarily produced in the body?
What does a Glasgow Coma Scale (GCS) score of ≤7 typically signify?
What does a Glasgow Coma Scale (GCS) score of ≤7 typically signify?
Which technique is effective in reducing intracranial pressure (ICP)?
Which technique is effective in reducing intracranial pressure (ICP)?
Which of the following methods is directly related to improving venous drainage to lower ICP?
Which of the following methods is directly related to improving venous drainage to lower ICP?
What physiological phenomenon may be observed in diffuse brain injury despite decreased cerebral blood flow (CBF)?
What physiological phenomenon may be observed in diffuse brain injury despite decreased cerebral blood flow (CBF)?
What is the typical range for normal cerebral autoregulation?
What is the typical range for normal cerebral autoregulation?
What triggers Cushing's reflex in response to physiological disturbances?
What triggers Cushing's reflex in response to physiological disturbances?
What is a potential consequence of having a low cerebral perfusion pressure (CPP)?
What is a potential consequence of having a low cerebral perfusion pressure (CPP)?
Which treatment goal is most appropriate when managing low cerebral perfusion pressure?
Which treatment goal is most appropriate when managing low cerebral perfusion pressure?
What defines excitotoxicity in the context of secondary brain injury?
What defines excitotoxicity in the context of secondary brain injury?
Which condition is characterized by increased intracranial pressure with no identifiable cause?
Which condition is characterized by increased intracranial pressure with no identifiable cause?
What kind of brain injury is notably associated with symptoms of 'walk and drop'?
What kind of brain injury is notably associated with symptoms of 'walk and drop'?
Which statement accurately describes diffuse axonal injury?
Which statement accurately describes diffuse axonal injury?
What characterizes a coup-contrecoup brain injury?
What characterizes a coup-contrecoup brain injury?
Which skull fracture is most serious and commonly associated with cerebrospinal fluid leaks?
Which skull fracture is most serious and commonly associated with cerebrospinal fluid leaks?
Which drug combination is recommended to manage acute increases in ICP?
Which drug combination is recommended to manage acute increases in ICP?
Which hematoma is caused by tearing of bridging veins between the cerebral cortex and draining sinuses?
Which hematoma is caused by tearing of bridging veins between the cerebral cortex and draining sinuses?
Which anesthetic induction agent promotes hemodynamic stability but should be avoided in acute trauma due to adrenocortical suppression?
Which anesthetic induction agent promotes hemodynamic stability but should be avoided in acute trauma due to adrenocortical suppression?
What positioning technique minimizes the risk of midcervical injury in the sitting position?
What positioning technique minimizes the risk of midcervical injury in the sitting position?
What systemic effect is commonly seen in response to traumatic brain injury?
What systemic effect is commonly seen in response to traumatic brain injury?
How does hyperventilation reduce ICP?
How does hyperventilation reduce ICP?
CSF is LIT AF = lateral ventricles, intraventricular foramen, third ventricle, cerebral aqueduct, fourth ventricle
CSF is LIT AF = lateral ventricles, intraventricular foramen, third ventricle, cerebral aqueduct, fourth ventricle
Where does cerebrospinal fluid (CSF) travel after exiting the fourth ventricle from the lateral apertures?
Where does cerebrospinal fluid (CSF) travel after exiting the fourth ventricle from the lateral apertures?
Where does cerebrospinal fluid (CSF) travel after exiting the medial apertures?
Where does cerebrospinal fluid (CSF) travel after exiting the medial apertures?
What is the normal cerebrospinal fluid (CSF) volume and rate of production?
What is the normal cerebrospinal fluid (CSF) volume and rate of production?
What is the site of absorption of cerebrospinal fluid (CSF)?
What is the site of absorption of cerebrospinal fluid (CSF)?
What is CSF absorption dependent on?
What is CSF absorption dependent on?
What does ICP measure?
What does ICP measure?
What is the normal range for intracranial pressure (ICP)?
What is the normal range for intracranial pressure (ICP)?
What are signs and symptoms of intracranial hypertension? (Select all that apply)
What are signs and symptoms of intracranial hypertension? (Select all that apply)
What should be avoided in treating increased intracranial pressure (ICP)?
What should be avoided in treating increased intracranial pressure (ICP)?
Which of the following methods are used to reduce cerebrospinal fluid (CSF)?
Which of the following methods are used to reduce cerebrospinal fluid (CSF)?
What methods can reduce cerebrovascular blood volume (CBV)?
What methods can reduce cerebrovascular blood volume (CBV)?
Which of the following factors affects cerebral blood flow (CBF)? (Select all that apply)
Which of the following factors affects cerebral blood flow (CBF)? (Select all that apply)
What is the correct equation for cerebral blood flow (CBF)?
What is the correct equation for cerebral blood flow (CBF)?
Which of the following best describes Poiseuille's Law?
Which of the following best describes Poiseuille's Law?
What is the equation for Cerebral Perfusion Pressure (CPP)?
What is the equation for Cerebral Perfusion Pressure (CPP)?
Which factors lead to decreased flow? (Select all that apply)
Which factors lead to decreased flow? (Select all that apply)
What does it mean that cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) are coupled?
What does it mean that cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) are coupled?
Which of the following would lead to an increase in cerebral metabolic rate for oxygen (CMRO2) and cerebral blood flow (CBF)? Select all that apply
Which of the following would lead to an increase in cerebral metabolic rate for oxygen (CMRO2) and cerebral blood flow (CBF)? Select all that apply
Which of the following would lead to a decrease in CMRO2 and CBF? (Select all that apply)
Which of the following would lead to a decrease in CMRO2 and CBF? (Select all that apply)
With TBI, cerebral autoregulation can be disrupted by which of the following factors? (Select all that apply)
With TBI, cerebral autoregulation can be disrupted by which of the following factors? (Select all that apply)
When cerebral autoregulation is disrupted, what changes would you see?
When cerebral autoregulation is disrupted, what changes would you see?
What occurs when Mean Arterial Pressure (MAP) is too high outside of autoregulation?
What occurs when Mean Arterial Pressure (MAP) is too high outside of autoregulation?
What occurs when Mean Arterial Pressure (MAP) is too low outside of autoregulation?
What occurs when Mean Arterial Pressure (MAP) is too low outside of autoregulation?
What is an adverse outcome indicator in TBI?
What is an adverse outcome indicator in TBI?
What occurs to cerebral blood flow (CBF) in areas of focal brain injury?
What occurs to cerebral blood flow (CBF) in areas of focal brain injury?
What is the primary physiological effect of acute brain swelling and edema? Select all that apply
What is the primary physiological effect of acute brain swelling and edema? Select all that apply
What are some causes of intracranial hypertension? (Select all that apply)
What are some causes of intracranial hypertension? (Select all that apply)
What is the normal range for Cerebral Perfusion Pressure (CPP)?
What is the normal range for Cerebral Perfusion Pressure (CPP)?
What is the goal cerebral perfusion pressure (CPP) during anesthesia?
What is the goal cerebral perfusion pressure (CPP) during anesthesia?
Which of the following is defined as the pressure gradient between systemic blood pressure (BP) and pressure in the cranial compartment?
Which of the following is defined as the pressure gradient between systemic blood pressure (BP) and pressure in the cranial compartment?
What can cause low Cerebral Perfusion Pressure (CPP)? (Select all that apply)
What can cause low Cerebral Perfusion Pressure (CPP)? (Select all that apply)
What causes high cerebral perfusion pressure (CPP)?
What causes high cerebral perfusion pressure (CPP)?
What can result from high cerebral perfusion pressure (CPP)?
What can result from high cerebral perfusion pressure (CPP)?
What is the mechanism of the cerebral ischemic response when mean arterial pressure (MAP) is less than 20 mmHg?
What is the mechanism of the cerebral ischemic response when mean arterial pressure (MAP) is less than 20 mmHg?
What are the signs and symptoms of Cushing's triad?
What are the signs and symptoms of Cushing's triad?
Cushing's triad are ___ signs that are the result of Cushing's reflex.
Cushing's triad are ___ signs that are the result of Cushing's reflex.
What is the most common site of brain herniation?
What is the most common site of brain herniation?
What causes a fixed, dilated pupil in traumatic brain injury (TBI)?
What causes a fixed, dilated pupil in traumatic brain injury (TBI)?
____ brain injury tends to be worse than primary brain injury
____ brain injury tends to be worse than primary brain injury
What are common features of secondary brain injury? (Select all that apply)
What are common features of secondary brain injury? (Select all that apply)
What is a common cause of epidural hematomas?
What is a common cause of epidural hematomas?
Where are intracerebral hematomas usually found?
Where are intracerebral hematomas usually found?
What typically causes subarachnoid hematomas?
What typically causes subarachnoid hematomas?
What type of skull fracture is the most common and typically does not require surgical intervention?
What type of skull fracture is the most common and typically does not require surgical intervention?
Where do diastatic fractures typically occur?
Where do diastatic fractures typically occur?
What nerve is at risk of being injured due to overstretching in the park bench position?
What nerve is at risk of being injured due to overstretching in the park bench position?
Which of the following nerves are at increased risk of injury in the sitting position? (Select all that apply)
Which of the following nerves are at increased risk of injury in the sitting position? (Select all that apply)
How do most induction agents decrease cerebral metabolic rate of oxygen (CMRO2) and cerebral blood flow (CBF)?
How do most induction agents decrease cerebral metabolic rate of oxygen (CMRO2) and cerebral blood flow (CBF)?
Which of the following anesthetic agents cause cerebral vasodilation? (Select all that apply)
Which of the following anesthetic agents cause cerebral vasodilation? (Select all that apply)
What effect does dexmedetomidine have on cerebral perfusion?
What effect does dexmedetomidine have on cerebral perfusion?
What is a risk of using nitrous oxide (N2O) as an anesthetic agent?
What is a risk of using nitrous oxide (N2O) as an anesthetic agent?
Which opioid is popular in neuroanesthesia due to its short context-sensitive half-time (CSHT)?
Which opioid is popular in neuroanesthesia due to its short context-sensitive half-time (CSHT)?
How does an increase in intrathoracic pressure typically affect cerebral perfusion pressure (CPP)?
How does an increase in intrathoracic pressure typically affect cerebral perfusion pressure (CPP)?
How does a decrease in intrathoracic pressure typically affect cerebral perfusion pressure (CPP)?
How does a decrease in intrathoracic pressure typically affect cerebral perfusion pressure (CPP)?
What is the primary mechanism by which increased intrathoracic pressure reduces cerebral perfusion pressure (CPP)?
What is the primary mechanism by which increased intrathoracic pressure reduces cerebral perfusion pressure (CPP)?
Why are ETCO2 and PaCO2 different?
Why are ETCO2 and PaCO2 different?
Why are lactated Ringer's solution and 5% albumin not recommended in patients with traumatic brain injury (TBI)?
Why are lactated Ringer's solution and 5% albumin not recommended in patients with traumatic brain injury (TBI)?
Why are colloids not recommended in traumatic brain injury (TBI)?
Why are colloids not recommended in traumatic brain injury (TBI)?
What is the trigger to transfuse blood in TBI patients? select 2
What is the trigger to transfuse blood in TBI patients? select 2
Match the following conditions with their effects on cerebral blood flow (CBF):
Match the following conditions with their effects on cerebral blood flow (CBF):
If a patient comes in with increased ICP, which actions can be taken to reduce it? (Select all that apply)
If a patient comes in with increased ICP, which actions can be taken to reduce it? (Select all that apply)
What is the relationship between cerebral blood flow (CBF) and arterial oxygen tension (PaO2)?
What is the relationship between cerebral blood flow (CBF) and arterial oxygen tension (PaO2)?
How does Ohm's Law relate to blood flow?
How does Ohm's Law relate to blood flow?
Flashcards
Monroe-Kellie Doctrine Components
Monroe-Kellie Doctrine Components
The cranial compartment is composed of blood, cerebrospinal fluid (CSF), and brain tissue. Changes in one area must be compensated for by changes in the other.
Increased Intracranial Pressure (ICP) effect
Increased Intracranial Pressure (ICP) effect
If one component of the cranial space increases and isn't balanced by a decrease in another, there's a rise in intracranial pressure, leading to herniation.
Gold standard for measuring ICP
Gold standard for measuring ICP
An intraventricular catheter is the most reliable tool for accurately measuring intracranial pressure.
CSF production site
CSF production site
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GCS ≤7 indication
GCS ≤7 indication
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ICP reduction method: hyperventilation
ICP reduction method: hyperventilation
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Diuretic for reducing ICP
Diuretic for reducing ICP
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ICP lowering & venous drainage
ICP lowering & venous drainage
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Diffuse brain injury & CBF
Diffuse brain injury & CBF
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Normal range for cerebral autoregulation
Normal range for cerebral autoregulation
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Low CPP
Low CPP
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Treatment goal for low CPP
Treatment goal for low CPP
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Excitotoxicity
Excitotoxicity
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Pseudotumor cerebri
Pseudotumor cerebri
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Epidural hematoma
Epidural hematoma
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Diffuse axonal injury
Diffuse axonal injury
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Coup-Contrecoup injury
Coup-Contrecoup injury
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Basilar skull fracture
Basilar skull fracture
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Propofol's effect on CPP
Propofol's effect on CPP
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Cerebral vasoconstrictors
Cerebral vasoconstrictors
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Cerebral vasodilators
Cerebral vasodilators
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Volatile agents on CBF
Volatile agents on CBF
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Defasciculating dose for succinylcholine
Defasciculating dose for succinylcholine
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Steroids in TBI
Steroids in TBI
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Preferred fluid in TBI
Preferred fluid in TBI
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Anesthetic avoided in TBI
Anesthetic avoided in TBI
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Drug Combo for Acute ICP
Drug Combo for Acute ICP
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Post-operative TBI: Essential Intervention
Post-operative TBI: Essential Intervention
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Mild TBI
Mild TBI
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Subdural Hematoma Cause
Subdural Hematoma Cause
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Anesthetic to Avoid in Trauma
Anesthetic to Avoid in Trauma
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Sitting Position: Midcervical Injury Prevention
Sitting Position: Midcervical Injury Prevention
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Systemic Effect of TBI
Systemic Effect of TBI
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How Hyperventilation Reduces ICP
How Hyperventilation Reduces ICP
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Study Notes
Monroe-Kellie Doctrine
- Primary components: Tissue, blood, cerebrospinal fluid (CSF), and oxygen
- Compensation: Increase in one component must be compensated by a decrease in another to maintain normal intracranial pressure (ICP)
Cranial Compartment Imbalance
- Result: Herniation occurs due to increased intracranial pressure (ICP)
Intracranial Pressure (ICP) Measurement
- Gold standard: Intraventricular catheter
Cerebrospinal Fluid (CSF) Production
- Typical site: Choroid plexus in the ventricles
Glasgow Coma Scale (GCS) Score
- Score ≤7: Indicates brain death
Intracranial Pressure Reduction Techniques
- Hyperventilation: Reduces PaCO2, leading to vasoconstriction and decreased ICP
- Head elevation: Improves venous drainage, reducing ICP
- Medications: Acetazolamide (carbonic anhydrase inhibitor), mannitol (osmotic diuretic)
Cerebral Autoregulation
- Normal range: 40-80 mmHg
- Disruptors: Hypoxia, Ischemia, Hypercapnia, Hypothermia, Vasoconstriction, Anemia, Hyperglycemia, Low ICP, Hyperoxia, Alkalosis, Hypoperfusion, Steroids
Cushing's Reflex
- Triggered by: Increased ICP exceeding mean arterial pressure (MAP)
- Clinical signs (Cushing's Triad): Bradycardia, Hypertension, Irregular respiration (or Cheyne-Stokes respirations)
Brain Herniation Types
- Common: Temporal uncus into brainstem
- Other types: Cerebellum into foramen magnum, etc.
Excitotoxicity
- Key change: Elevated glutamate levels
Treatment Goal for Low CPP
- Maintain ICP above 20 mmHg
- Increase MAP (mean arterial pressure) or Decrease ICP
Secondary Brain Injury
- Characterized by: Metabolic and inflammatory changes
- Examples: Coup-contrecoup injury, Excitotoxicity, Traumatic subarachnoid hemorrhage
Idiopathic Intracranial Hypertension
- Cause: Unknown
- Condition: Increased intracranial pressure
- Related symptoms: Pseudotumor cerebri
Brain Injury Symptoms
- "Walk and drop" symptoms: Epidural hematoma
Cerebral Edema Reduction
- Methods: Vasoconstrictors, Hypertonic saline, Reduced intrathoracic pressure
Diffuse Axonal Injury Hallmark
- Prolonged Loss of Consciousness (LOC) >6 hours, due to nerve cell shearing
Coup-Contrecoup Injury Distinction
- Bilateral injuries: Occur at both the site of impact & opposite site
Anesthetic Agents and ICP
- Agents to avoid in acute trauma: Due to adrenocortical suppression (e.g., Ketamine)
- Agents decreasing CBF and cerebral oxygen metabolism (CMRO2): Propofol, barbiturates, etomidate
Steroid Use in TBI Management
- Detrimental effects: Glucose increases, exacerbates secondary brain injury, and impairs immune response
Fluid Choice in TBI Management
- Preferred: Isotonic saline (0.9% NaCl) or Lactated Ringer's solution
- Avoid solutions that can increase intracranial pressure, such as hypotonic or hyperglycemic solutions.
Anesthetic Considerations
- Important use: Hyperventilation decreases intracranial pressure by decreasing cerebral blood flow
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Description
This quiz explores the Monroe-Kellie Doctrine and its implications on intracranial pressure (ICP). Test your knowledge on factors affecting ICP, measurement techniques, and cerebral autoregulation. Additionally, understand the consequences of cranial compartment imbalance and the implications of the Glasgow Coma Scale.
