Anesthesia Pharmacology: Anesthesia Practice Questions

Inhaled anesthetics and intracranial pressure:
1. increases in ICP parallel increases in cerebral blood flow
2. hypocapnia tends to accentuate increases in ICP caused by inhaled anesthetics
3. both
4. neither
Intracranial pressure & inhale anesthetics: action hypocapnic patients with intracranial masses:
1. desflurane (Suprane) at < 0.8 MAC: no increase in ICP
2. desflurane (Suprane) at > 1.1 MAC: increases ICP about 7 mm Hg
3. both
4. neither
Hyperventilation decreases the likelihood that inhaled anesthetics will increase ICP {PaCO2 decreased to about 30 mm Hg):
1. true
2. false
Intracranial pressure and inhaled anesthetics:
1. halothane (Fluothane): hyperventilation before halothane (Fluothane) introduction
2. isoflurane (Forane): hyperventilation concurrent with anesthetic administration
3. enflurane (Ethrane) +hyperventilation: increased seizure activity
4. A & B
5. A, B & C
Direct dilation of cerebral vasculature -- causing on increase in cerebral blood flow
1. halothane (Fluothane)
2. enflurane (Ethrane)
3. sevoflurane (Sevorane, Ultane)
4. desflurane (Suprane)
5. all of the above
Increased cerebral blood flow:
1. increases the amount of intracranial blood
2. increases ICP under all conditions
3. both
4. neither
Desflurane (Suprane): not recommended for patients with CNS space-filling lesions
1. true
2. false
Cerebral blood flow & nitrous oxide:
1. nitrous oxide may increase CBF and ICP
2. nitrous oxide + volatile anesthetics: reduced increases in CBF than with nitrous oxide alone
3. nitrous oxide increases in CBF and ICP may be reduced/prevented by barbiturates and hypocapnia
4. A & C
5. A, B & C
Volatile anesthetic agent of choice for patients with cerebral ischemia patients who may develop cerebral ischemia:
1. enflurane (Ethrane)
2. halothane (Fluothane)
3. isoflurane (Forane)
4. sevoflurane (Sevorane, Ultane)
5. all the above equally effective
Barbiturates: cerebral metabolic rates & CBF:
1. increases mean arterial pressure which increases cerebral perfusion pressure
2. decreases cerebral metabolic rate and CBF
3. except for methohexital (Brevital), effective in controlling epileptiform CNS activity
4. B & C
5. A & C
Etomidate: --
1. direct acting vasodilator
2. significant cardiovascular depression
3. reduced adrenocortical response to stress was prolonged use
4. increased CBF
5. increased CMR
Propofol (Diprivan) --
1. increased ICP
2. increased CBF
3. increased CMR
4. longer-lasting ventilatory depression compared to barbiturates
Benzodiazepines:
1. reduces CBF
2. reduces ICP
3. reduces CMR
4. flumazenil (Romazicon) reduces CMR, CBF, and ICP effects of midazolam (Versed)
5. all of the above
Ketamine (Ketalar):
1. Increases CBF and CMR
2. activates certain brain regions
3. commonly used in neuroanesthesia
4. A & B
5. A, B & C
Opioids --
1. morphine: minor reduction/no effect on CBF
2. alfentanil (Alfenta): increases CSF pressure in brain tumor patients
3. fentanyl (Sublimaze): minor reduction/no effect on CMR
4. B & C
5. A, B & C
Factor(s) causing significant increases in ICP in a patient with an intracranial tumor:
1. increasing cerebral edema surrounding a lesion
2. development of a hemorrhagic, necrotic, center volume which may increase in volume rapidly
3. small increases in arterial pressures can cause can increase in ICP
4. A & C
5. A, B & C
Compensatory mechanism(s) to accommodate intracranial tumor growth:
1. cerebral vein compression
2. CSF compartment compression
3. both
4. neither
In management of intracranial volume the primary goal of reducing intracranial volume may utilize both pharmacological and nonpharmacological interventions
1. true
2. false
Pharmacological agents (categories) which may be useful in reducing intracranial volume
1. diuretics, e.g. mannitol (Osmitrol)
2. corticosteroids
3. anesthetic agents
4. A & B
5. A, B & C
Hypothermia may be useful in reducing intracranial volume:
1. true
2. false