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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?
- Induce complete anesthesia without any cerebral activity
- Provide adequate oxygen and glucose to meet metabolic demands (correct)
- Minimize muscle relaxation during procedures
- Reduce blood flow to the brain
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)?
- Laser doppler blood flow (correct)
- Nitrous oxide wash-in (correct)
- Radioactive xenon clearance (correct)
- ICP monitors (e.g. intraventricular catheters) (correct)
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?
- Electroencephalography
- Jugular venous oximetry (correct)
- Intracranial pressure monitoring
- Evoked potentials
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)
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?
Which statement best describes the relationship between EEG activity and metabolic conditions?
Which statement best describes the relationship between EEG activity and metabolic conditions?
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?
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?
What happens to beta wave activity in response to hypoxia or ischemia?
What happens to beta wave activity in response to hypoxia or ischemia?
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)
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)
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)
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?
What comprises the electrical activity recorded by EEG?
What comprises the electrical activity recorded by EEG?
What is the nasion?
What is the nasion?
What is the inion?
What is the inion?
When are the medium frequency, higher amplitude alpha waves typically seen?
When are the medium frequency, higher amplitude alpha waves typically seen?
Which waves are associated with deep coma, anesthesia, and hypoxia?
Which waves are associated with deep coma, anesthesia, and hypoxia?
What type of wave activity is primarily observed in awake EEG recordings?
What type of wave activity is primarily observed in awake EEG recordings?
What can cause EEG depression? (Select all that apply)
What can cause EEG depression? (Select all that apply)
What are epileptiform patterns and spikes indicative of on an EEG?
What are epileptiform patterns and spikes indicative of on an EEG?
What is burst suppression in EEG patterns characterized by?
What is burst suppression in EEG patterns characterized by?
What are causes of burst suppression? (Select all that apply)
What are causes of burst suppression? (Select all that apply)
What does unilateral burst suppression indicate?
What does unilateral burst suppression indicate?
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?
What occurs to the EEG as the level of anesthesia deepens?
What occurs to the EEG as the level of anesthesia deepens?
What occurs as a result of most IV anesthetics and inhalation agents?
What occurs as a result of most IV anesthetics and inhalation agents?
How does hypothermia alter EEG readings?
How does hypothermia alter EEG readings?
How does ketamine affect EEG readings?
How does ketamine affect EEG readings?
Which agent does not reduce BIS when used as a sole agent?
Which agent does not reduce BIS when used as a sole agent?
Which agent is known to cause increased beta wave activity?
Which agent is known to cause increased beta wave activity?
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)
During which stages of anesthesia is increased beta wave activity observed?
During which stages of anesthesia is increased beta wave activity observed?
At what minimum alveolar concentration (MAC) is brain isoelectric activity observed?
At what minimum alveolar concentration (MAC) is brain isoelectric activity observed?
Which of the following drugs is characterized by epileptiform activity?
Which of the following drugs is characterized by epileptiform activity?
Which drug is characterized by myoclonus with no epileptiform activity?
Which drug is characterized by myoclonus with no epileptiform activity?
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.
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)
20-30 sec lag time between EEG measurement and BIS value
20-30 sec lag time between EEG measurement and BIS value
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)
Which agents decrease bispectral index (BIS) without a sedative effect?
Which agents decrease bispectral index (BIS) without a sedative effect?
What are somatosensory evoked potentials? (select 2)
What are somatosensory evoked potentials? (select 2)
What is the best anesthetic technique for SSEP monitoring?
What is the best anesthetic technique for SSEP monitoring?
Which agents should be avoided in SSEP monitoring? (select 3)
Which agents should be avoided in SSEP monitoring? (select 3)
What are the three types of sensory evoked potentials?
What are the three types of sensory evoked potentials?
What is the preferred anesthetic when monitoring Visual Evoked Potentials (VEPs)?
What is the preferred anesthetic when monitoring Visual Evoked Potentials (VEPs)?
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?
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?
What are the peaks and troughs of waveforms called in evoked potentials?
What are the peaks and troughs of waveforms called in evoked potentials?
A BAEP with increased latency of __ mS is a significant finding
A BAEP with increased latency of __ mS is a significant finding
Where are MEPs recorded in response to depolarization of the motor cortex?
Where are MEPs recorded in response to depolarization of the motor cortex?
What is the preferred anesthetic management for monitoring motor evoked potentials (MEPs)?
What is the preferred anesthetic management for monitoring motor evoked potentials (MEPs)?
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)
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)?
Which cranial nerves can be monitored via EMG? (Select all that apply)
Which cranial nerves can be monitored via EMG? (Select all that apply)
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?
Match the following CBF limits (ml/100g/min) with their corresponding conditions:
Match the following CBF limits (ml/100g/min) with their corresponding conditions:
Match the Cerebral Perfusion Pressure (CPP) values with their corresponding events:
Match the Cerebral Perfusion Pressure (CPP) values with their corresponding events:
What is the critical PaO2 level considered to be?
What is the critical PaO2 level considered to be?
What is the critical level of paCO2 considered to be hazardous?
What is the critical level of paCO2 considered to be hazardous?
What factors determine cerebral blood flow (CBF)?
What factors determine cerebral blood flow (CBF)?
What are NIM (Nerve Integrity Monitors) ETTs used for?
What are NIM (Nerve Integrity Monitors) ETTs used for?
What can EEG be used to monitor in neuroanesthesia?
What can EEG be used to monitor in neuroanesthesia?
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
What are the limitations of transcranial Doppler ultrasonography? (Select all that apply)
What are the limitations of transcranial Doppler ultrasonography? (Select all that apply)
What is transcranial Doppler ultrasonography used to measure?
What is transcranial Doppler ultrasonography used to measure?
What is the primary purpose of microdialysis catheters in neuroanesthesia?
What is the primary purpose of microdialysis catheters in neuroanesthesia?
What is Indocyanine green video angiography used to measure during aneurysm surgery?
What is Indocyanine green video angiography used to measure during aneurysm surgery?
Where are supratentorial pressures measured?
Where are supratentorial pressures measured?
What is the jugular bulb?
What is the jugular bulb?
What is the purpose of jugular venous oxygen saturation?
What is the purpose of jugular venous oxygen saturation?
What are the limitations of jugular venous oxygen saturation measurement? select 2
What are the limitations of jugular venous oxygen saturation measurement? select 2
What is near infrared spectroscopy in the context of cerebral oximetry?
What is near infrared spectroscopy in the context of cerebral oximetry?
What are the limitations of cerebral oximetry? (Select all that apply)
What are the limitations of cerebral oximetry? (Select all that apply)
What are precordial Dopplers used to detect?
What are precordial Dopplers used to detect?
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)
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?
What is characteristic of the EEG pattern of propofol?
What is characteristic of the EEG pattern of propofol?
What is a limitation of the Bispectral Index (BIS)?
What is a limitation of the Bispectral Index (BIS)?
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)
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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
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