EDAIC - European Diploma in Anesthesiology and Intensive Care Neuroanesthesia and Neuromonitoring Questions and Answers

Question 1

A 58-year-old male is undergoing surgical clipping of a ruptured anterior communicating artery aneurysm.
Intraoperatively, the surgeons announce sudden, brisk bleeding from the aneurysm dome.
Which of the following is the most appropriate immediate anesthetic management step?

Accepted Answer

Induce profound hypotension (MAP 40-50 mmHg) transiently.

Answer

Administer a bolus of norepinephrine to maintain cerebral perfusion pressure.

Answer

Start a rapid infusion of 3% hypertonic saline.

Answer

Administer a bolus of mannitol 1 g/kg.

Question 2

Which of the following statements most accurately describes the effect of propofol on cerebral physiology?

Accepted Answer

It decreases both CBF and CMRO2 while preserving the coupling between them.

Answer

It causes cerebral vasodilation, increasing cerebral blood flow (CBF) while decreasing the cerebral metabolic rate of oxygen (CMRO2).

Answer

It significantly impairs cerebral autoregulation at clinical doses.

Answer

It increases CMRO2 but decreases CBF, leading to a risk of ischemia.

Question 3

A patient is undergoing spinal surgery with monitoring of Somatosensory Evoked Potentials (SSEPs). Which anesthetic agent, when used as a primary agent, would cause the most significant dose-dependent decrease in SSEP amplitude and increase in latency?

Accepted Answer

Isoflurane

Answer

Ketamine

Answer

Propofol

Answer

Remifentanil

Question 4

During transcranial Doppler (TCD) monitoring of a patient 7 days after a subarachnoid hemorrhage, the mean flow velocity in the middle cerebral artery (MCA) is measured at 180 cm/s. The mean flow velocity in the ipsilateral extracranial internal carotid artery (ICA) is 50 cm/s. What is the most likely interpretation of these findings?

Accepted Answer

Severe cerebral vasospasm

Answer

Normal cerebral blood flow

Answer

Cerebral hyperemia

Answer

Intracranial hypertension

Question 5

Which of the following is a recognized limitation of Bispectral Index (BIS) monitoring in neuroanesthesia?

Accepted Answer

BIS values can be paradoxically elevated by ketamine.

Answer

BIS values are reliably correlated with the anesthetic depth produced by nitrous oxide.

Answer

It accurately reflects hypnotic state during high-dose remifentanil infusion.

Answer

The presence of a burst suppression pattern on EEG will falsely elevate the BIS value.

Question 6

A patient with a traumatic brain injury has a sustained intracranial pressure (ICP) of 25 mmHg. A bolus of mannitol is administered. What is the primary, initial mechanism by which mannitol reduces ICP?

Accepted Answer

Creating an osmotic gradient across the blood-brain barrier, drawing water from brain parenchyma.

Answer

Inducing a potent systemic diuresis, thereby dehydrating the entire body.

Answer

Directly constricting cerebral arterioles through a receptor-mediated effect.

Answer

Decreasing the rate of cerebrospinal fluid (CSF) production.