Podcast
Questions and Answers
What is the primary goal of neuro anesthesia as it relates to brain function?
What is the primary goal of neuro anesthesia as it relates to brain function?
Which methods are used specifically for monitoring blood flow to the brain (CBF and ICP)?
Which methods are used specifically for monitoring blood flow to the brain (CBF and ICP)?
What type of monitoring would directly assess the metabolic state of brain tissue?
What type of monitoring would directly assess the metabolic state of brain tissue?
Which of the following techniques are primarily used for monitoring brain function during anesthesia? (select all that apply)
Which of the following techniques are primarily used for monitoring brain function during anesthesia? (select all that apply)
Signup and view all the answers
What are beta waves characterized by in terms of frequency and amplitude when a person is awake?
What are beta waves characterized by in terms of frequency and amplitude when a person is awake?
Signup and view all the answers
Which statement best describes the relationship between EEG activity and metabolic conditions?
Which statement best describes the relationship between EEG activity and metabolic conditions?
Signup and view all the answers
In the International 10-20 system, odd-numbered electrodes are positioned in which hemisphere?
In the International 10-20 system, odd-numbered electrodes are positioned in which hemisphere?
Signup and view all the answers
Which type of brainwave is associated with children during normal sleep and not associated with adults?
Which type of brainwave is associated with children during normal sleep and not associated with adults?
Signup and view all the answers
What happens to beta wave activity in response to hypoxia or ischemia?
What happens to beta wave activity in response to hypoxia or ischemia?
Signup and view all the answers
Which of the following are the 3 categories of neurophysiologic monitoring? (Select all that apply)
Which of the following are the 3 categories of neurophysiologic monitoring? (Select all that apply)
Signup and view all the answers
Which of the following devices are used for monitoring cerebral metabolism? (Select all that apply)
Which of the following devices are used for monitoring cerebral metabolism? (Select all that apply)
Signup and view all the answers
Which of the following are NOT recorded by EEG? (Select all that apply)
Which of the following are NOT recorded by EEG? (Select all that apply)
Signup and view all the answers
Which cells are primarily responsible for producing the electrical activity that is detected by an EEG?
Which cells are primarily responsible for producing the electrical activity that is detected by an EEG?
Signup and view all the answers
What comprises the electrical activity recorded by EEG?
What comprises the electrical activity recorded by EEG?
Signup and view all the answers
What is the nasion?
What is the nasion?
Signup and view all the answers
What is the inion?
What is the inion?
Signup and view all the answers
When are the medium frequency, higher amplitude alpha waves typically seen?
When are the medium frequency, higher amplitude alpha waves typically seen?
Signup and view all the answers
Which waves are associated with deep coma, anesthesia, and hypoxia?
Which waves are associated with deep coma, anesthesia, and hypoxia?
Signup and view all the answers
What type of wave activity is primarily observed in awake EEG recordings?
What type of wave activity is primarily observed in awake EEG recordings?
Signup and view all the answers
What can cause EEG depression? (Select all that apply)
What can cause EEG depression? (Select all that apply)
Signup and view all the answers
What are epileptiform patterns and spikes indicative of on an EEG?
What are epileptiform patterns and spikes indicative of on an EEG?
Signup and view all the answers
What is burst suppression in EEG patterns characterized by?
What is burst suppression in EEG patterns characterized by?
Signup and view all the answers
What are causes of burst suppression? (Select all that apply)
What are causes of burst suppression? (Select all that apply)
Signup and view all the answers
What does unilateral burst suppression indicate?
What does unilateral burst suppression indicate?
Signup and view all the answers
What is the gold standard for EEG monitoring that is rarely achieved in the OR?
What is the gold standard for EEG monitoring that is rarely achieved in the OR?
Signup and view all the answers
What occurs to the EEG as the level of anesthesia deepens?
What occurs to the EEG as the level of anesthesia deepens?
Signup and view all the answers
What occurs as a result of most IV anesthetics and inhalation agents?
What occurs as a result of most IV anesthetics and inhalation agents?
Signup and view all the answers
How does hypothermia alter EEG readings?
How does hypothermia alter EEG readings?
Signup and view all the answers
How does ketamine affect EEG readings?
How does ketamine affect EEG readings?
Signup and view all the answers
Which agent does not reduce BIS when used as a sole agent?
Which agent does not reduce BIS when used as a sole agent?
Signup and view all the answers
Which agent is known to cause increased beta wave activity?
Which agent is known to cause increased beta wave activity?
Signup and view all the answers
Which of the following brain wave patterns are prevalent during general anesthesia? (Select all that apply)
Which of the following brain wave patterns are prevalent during general anesthesia? (Select all that apply)
Signup and view all the answers
During which stages of anesthesia is increased beta wave activity observed?
During which stages of anesthesia is increased beta wave activity observed?
Signup and view all the answers
At what minimum alveolar concentration (MAC) is brain isoelectric activity observed?
At what minimum alveolar concentration (MAC) is brain isoelectric activity observed?
Signup and view all the answers
Which of the following drugs is characterized by epileptiform activity?
Which of the following drugs is characterized by epileptiform activity?
Signup and view all the answers
Which drug is characterized by myoclonus with no epileptiform activity?
Which drug is characterized by myoclonus with no epileptiform activity?
Signup and view all the answers
The development of new ___ waves during anesthesia maintenance indicates a risk for ischemia.
The development of new ___ waves during anesthesia maintenance indicates a risk for ischemia.
Signup and view all the answers
Which of the following are considered mimics for cerebral ischemia? (Select all that apply)
Which of the following are considered mimics for cerebral ischemia? (Select all that apply)
Signup and view all the answers
20-30 sec lag time between EEG measurement and BIS value
20-30 sec lag time between EEG measurement and BIS value
Signup and view all the answers
Which of the following factors impair the accuracy of bispectral index (BIS) monitoring? (Select all that apply)
Which of the following factors impair the accuracy of bispectral index (BIS) monitoring? (Select all that apply)
Signup and view all the answers
Which agents decrease bispectral index (BIS) without a sedative effect?
Which agents decrease bispectral index (BIS) without a sedative effect?
Signup and view all the answers
What are somatosensory evoked potentials? (select 2)
What are somatosensory evoked potentials? (select 2)
Signup and view all the answers
What is the best anesthetic technique for SSEP monitoring?
What is the best anesthetic technique for SSEP monitoring?
Signup and view all the answers
Which agents should be avoided in SSEP monitoring? (select 3)
Which agents should be avoided in SSEP monitoring? (select 3)
Signup and view all the answers
What are the three types of sensory evoked potentials?
What are the three types of sensory evoked potentials?
Signup and view all the answers
What is the preferred anesthetic when monitoring Visual Evoked Potentials (VEPs)?
What is the preferred anesthetic when monitoring Visual Evoked Potentials (VEPs)?
Signup and view all the answers
Which sensory evoked potential is unique in its resistance to the influence of anesthetic agents?
Which sensory evoked potential is unique in its resistance to the influence of anesthetic agents?
Signup and view all the answers
You note a 50% decrease in amplitude during evoked potential monitoring during surgery. What is this indicative of?
You note a 50% decrease in amplitude during evoked potential monitoring during surgery. What is this indicative of?
Signup and view all the answers
What are the peaks and troughs of waveforms called in evoked potentials?
What are the peaks and troughs of waveforms called in evoked potentials?
Signup and view all the answers
A BAEP with increased latency of __ mS is a significant finding
A BAEP with increased latency of __ mS is a significant finding
Signup and view all the answers
Where are MEPs recorded in response to depolarization of the motor cortex?
Where are MEPs recorded in response to depolarization of the motor cortex?
Signup and view all the answers
What is the preferred anesthetic management for monitoring motor evoked potentials (MEPs)?
What is the preferred anesthetic management for monitoring motor evoked potentials (MEPs)?
Signup and view all the answers
What is the difference between the SEP and EEG response to inhaled anesthetics? (select 2)
What is the difference between the SEP and EEG response to inhaled anesthetics? (select 2)
Signup and view all the answers
What is the difference between the amplitude of waves in Somatosensory Evoked Potentials (SEPs) and Electroencephalography (EEG)?
What is the difference between the amplitude of waves in Somatosensory Evoked Potentials (SEPs) and Electroencephalography (EEG)?
Signup and view all the answers
Which cranial nerves can be monitored via EMG? (Select all that apply)
Which cranial nerves can be monitored via EMG? (Select all that apply)
Signup and view all the answers
What is the normal range of cerebral blood flow (CBF) in mL/100g?
What is the normal range of cerebral blood flow (CBF) in mL/100g?
Signup and view all the answers
Match the following CBF limits (ml/100g/min) with their corresponding conditions:
Match the following CBF limits (ml/100g/min) with their corresponding conditions:
Signup and view all the answers
Match the Cerebral Perfusion Pressure (CPP) values with their corresponding events:
Match the Cerebral Perfusion Pressure (CPP) values with their corresponding events:
Signup and view all the answers
What is the critical PaO2 level considered to be?
What is the critical PaO2 level considered to be?
Signup and view all the answers
What is the critical level of paCO2 considered to be hazardous?
What is the critical level of paCO2 considered to be hazardous?
Signup and view all the answers
What factors determine cerebral blood flow (CBF)?
What factors determine cerebral blood flow (CBF)?
Signup and view all the answers
What are NIM (Nerve Integrity Monitors) ETTs used for?
What are NIM (Nerve Integrity Monitors) ETTs used for?
Signup and view all the answers
What can EEG be used to monitor in neuroanesthesia?
What can EEG be used to monitor in neuroanesthesia?
Signup and view all the answers
What are the limitations of laser Doppler flowmetry in measuring cerebral blood flow (CBF)? select 2
What are the limitations of laser Doppler flowmetry in measuring cerebral blood flow (CBF)? select 2
Signup and view all the answers
What are the limitations of transcranial Doppler ultrasonography? (Select all that apply)
What are the limitations of transcranial Doppler ultrasonography? (Select all that apply)
Signup and view all the answers
What is transcranial Doppler ultrasonography used to measure?
What is transcranial Doppler ultrasonography used to measure?
Signup and view all the answers
What is the primary purpose of microdialysis catheters in neuroanesthesia?
What is the primary purpose of microdialysis catheters in neuroanesthesia?
Signup and view all the answers
What is Indocyanine green video angiography used to measure during aneurysm surgery?
What is Indocyanine green video angiography used to measure during aneurysm surgery?
Signup and view all the answers
Where are supratentorial pressures measured?
Where are supratentorial pressures measured?
Signup and view all the answers
What is the jugular bulb?
What is the jugular bulb?
Signup and view all the answers
What is the purpose of jugular venous oxygen saturation?
What is the purpose of jugular venous oxygen saturation?
Signup and view all the answers
What are the limitations of jugular venous oxygen saturation measurement? select 2
What are the limitations of jugular venous oxygen saturation measurement? select 2
Signup and view all the answers
What is near infrared spectroscopy in the context of cerebral oximetry?
What is near infrared spectroscopy in the context of cerebral oximetry?
Signup and view all the answers
What are the limitations of cerebral oximetry? (Select all that apply)
What are the limitations of cerebral oximetry? (Select all that apply)
Signup and view all the answers
What are precordial Dopplers used to detect?
What are precordial Dopplers used to detect?
Signup and view all the answers
Which of the following monitors are used to monitor intracranial pressure (ICP)? (Select all that apply)
Which of the following monitors are used to monitor intracranial pressure (ICP)? (Select all that apply)
Signup and view all the answers
Which anesthetic is known to cause non-rapid eye movement sleep patterns on the EEG?
Which anesthetic is known to cause non-rapid eye movement sleep patterns on the EEG?
Signup and view all the answers
What is characteristic of the EEG pattern of propofol?
What is characteristic of the EEG pattern of propofol?
Signup and view all the answers
What is a limitation of the Bispectral Index (BIS)?
What is a limitation of the Bispectral Index (BIS)?
Signup and view all the answers
Which types of operations have a high potential for damaging cranial nerves? (Select all that apply)
Which types of operations have a high potential for damaging cranial nerves? (Select all that apply)
Signup and view all the answers
Study Notes
Neuroanesthesia Goals
- Overall Goal: Ensure brain receives sufficient oxygen and glucose
-
Perioperative Goals:
- Maintain favorable blood and oxygen supply
- Prevent brain herniation
- Facilitate muscle relaxation
Risks
- Patients with neurological disease undergoing surgery are at higher risk of brain hypoxia and ischemia
Intraoperative Monitoring
- Goal: Improve patient outcomes via early detection of issues and adjusting anesthetic/surgical procedures
- Standard Monitors: EKG, BP, SPO2, ETCO2, temperature, precordial or esophageal stethoscope
- Expanded Monitors: Art line, CVP, PA, precordial doppler
Categories of Neurophysiologic Monitoring
- Function: EEG, evoked potentials, electromyography
-
Blood Flow: CBF, ICP
-
CBF Measurement Methods:
- Nitrous oxide wash-in
- Radioactive xenon clearance
- Laser Doppler blood flow
-
ICP Measurement Methods:
- Intraventricular catheter
- Sub-arachnoid bolt
- Epidural catheter
- Fiberoptic parenchymal catheter
-
CBF Measurement Methods:
-
Metabolism:
- Invasive: Intercerebral PO2 electrode
- Non-invasive: Transcranial cerebral oximetry and jugular venous oximetry
EEG
- Definition: Recording of brain's electrical activity from the cerebral cortex
-
Source: Pyramidal cells in the cerebral cortex
- Result of summation of excitatory and inhibitory postsynaptic potentials
- Primarily records cortical activity: Limited recording of subcortical structures, spinal cord, cranial nerves, and peripheral nerves
- Oxygen and Glucose Dependency: EEG is significantly impacted by oxygen and glucose supply
-
Monitoring Locations:
- Scalp: Electrically neutral area
- Electrodes can be taped or use small needles
-
International 10-20 System: Standardized electrode placement
- 10 or 20% of skull circumference between electrodes
- Even numbers: Right Hemisphere
- Odd numbers: Left Hemisphere
-
Landmarks:
- Nasion: Depressed area between eyes
- Inion: Lowest point of the skull
- Scalp: Electrically neutral area
-
EEG Wave Patterns:
- Beta waves: High frequency, low amplitude (awake)
- Alpha waves: Medium frequency, higher amplitude (awake and relaxed)
- Theta waves: Low frequency (children during sleep)
- Delta waves: Low frequency, high amplitude (deep coma, anesthesia, hypoxia)
- EEG Reflects: Brain wakefulness and metabolic activity
-
EEG Depression Causes
- Decreased blood flow
- Reduced oxygen supply
- Insufficient glucose
- Awake EEG: Dominated by high frequency, low amplitude beta waves
-
Hypoxia/Ischemia EEG Changes:
- Initial increase in beta activity (compensation mechanism)
- Slow theta waves
- Disappearance of beta waves
- Low amplitude delta waves
Abnormal EEG Patterns
- Generalized slowing: Slowed activity
- Focal or localized slow activity: Slow activity in a specific area
- Periodic patterns: Recurring patterns
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz covers the key goals and monitoring strategies in neuroanesthesia, focusing on maintaining brain function during surgery. It addresses risks associated with neurological diseases, intraoperative monitoring techniques, and methods for measuring cerebral blood flow and intracranial pressure.
