EDAIC Neuroanesthesia and Neuromonitoring 4

Question 1

A patient undergoing spine surgery develops loss of MEP signals bilaterally 30 minutes after distraction. The FIRST response should be:

Accepted Answer

Immediately notify the surgeon and consider reducing distraction

Answer

Loss of MEPs during spine distraction suggests cord ischemia or mechanical injury; the surgeon must be alerted immediately to reduce distraction and relieve the insult.

Question 2

Which volatile anesthetic concentration most reliably abolishes MEP signals and should be avoided during spine surgery with neuromonitoring?

Accepted Answer

>1.0 MAC

Answer

Volatile agents at greater than 1.0 MAC consistently suppress MEPs to an unmonitorable level, making TIVA with propofol/remifentanil preferable for spine neuromonitoring.

Question 3

Near-infrared spectroscopy (NIRS) monitors cerebral oxygenation in which vascular territory?

Accepted Answer

Predominantly venous (25% arterial, 75% venous)

Answer

NIRS measures regional cerebral oxygen saturation (rSO2) in a predominantly venous (75%) compartment, reflecting overall cerebral oxygen supply-demand balance.

Question 4

Which anesthetic technique is associated with the lowest incidence of postoperative cognitive dysfunction (POCD) in elderly patients undergoing major surgery?

Accepted Answer

Regional anesthesia alone

Answer

Regional anesthesia avoids systemic effects of general anesthetic agents on the CNS and is associated with the lowest rates of POCD in elderly surgical patients.

Question 5

In a patient with a known intracranial arteriovenous malformation (AVM) presenting for embolization, which hemodynamic concern is specific to AVM resection?

Accepted Answer

Normal perfusion pressure breakthrough

Answer

Normal perfusion pressure breakthrough occurs when chronic hypoperfusion surrounding an AVM is reversed post-resection, causing hyperemia and hemorrhage in surrounding brain.

EDAIC - European Diploma in Anesthesiology and Intensive Care Practice Test

EDAIC - European Diploma in Anesthesiology and Intensive Care Practice Test

EDAIC Neuroanesthesia and Neuromonitoring 4