BCA Neuroanesthesia & Neurosurgical Procedures Flashcards

Which volatile anesthetic is MOST likely to increase intracranial pressure at concentrations above 1 MAC?

Answer: All volatile agents have similar ICP effects above 1 MAC

All volatile anesthetic agents cause dose-dependent cerebral vasodilation and ICP elevation above 1 MAC; the effect is dose-dependent rather than agent-specific.

In a patient with a traumatic brain injury (TBI), the TARGET mean arterial pressure (MAP) to maintain cerebral perfusion pressure (CPP) of at least 60 mmHg with an ICP of 20 mmHg is:

Answer: 80 mmHg

CPP = MAP − ICP; to achieve CPP ≥ 60 mmHg with ICP of 20 mmHg, MAP must be ≥ 80 mmHg.

Mannitol reduces intracranial pressure primarily by:

Answer: Creating an osmotic gradient that draws water from brain parenchyma

Mannitol establishes an osmotic gradient across the blood–brain barrier, drawing free water from brain tissue into the intravascular space and reducing brain volume.

Which neuromuscular blocking agent is CONTRAINDICATED in patients with acute denervation injury (e.g., spinal cord injury within 72 hours)?

Answer: Succinylcholine

Succinylcholine causes massive potassium release from upregulated acetylcholine receptors in denervated muscle, risking fatal hyperkalemic cardiac arrest.

During awake craniotomy for brain mapping, the anesthetic technique that best allows intraoperative neurological testing while maintaining patient comfort is:

Answer: Asleep-awake-asleep technique with dexmedetomidine/propofol

The asleep-awake-asleep technique using dexmedetomidine and/or propofol provides sedation during opening/closing while allowing an awake, cooperative patient for cortical mapping.

Cerebral autoregulation maintains constant cerebral blood flow (CBF) over a MAP range of approximately:

Answer: 50–150 mmHg

Normal cerebral autoregulation maintains constant CBF across a MAP of approximately 50–150 mmHg; outside this range, CBF becomes pressure-passive.