STUDY NOTES:

NEUROANESTHESIA
CBF: Cerebral Blood Flow
CO: Cardiac Output
CMRO2: Cerebra; Metabolic Rate
PP: Perfusion Pressure
CPP: Cerebral Perfusion Pressure

 : Directly Proportional
: Indirectly Proportional

   

PHYSIO:
Hyperglycemia is asso’d w/ worsened neurologic outcomes under conditions of neuronal
ischemia (i.e. seixure)
nl CBF is 20% of the CO & is responsible for 20% of the body’s O2 consumption
nl CBF= 50cc/100gm of brain tissue
If: CBF=20cc/100gm/min EEG slowing begins
CBF=15 cc/100gn/min isoelectric EEG readings
CBF<12cc/100gn/min EEG flat line begins
CBF= 6 12cc/100gn/min Brain infarction
CBF  1-2 cc/100gm brain tissue for each 1 mmHg  in PaCO2
CBF  if PaCO2  < 50mmHg
CBF  by 0.7 mmHg for every 1cm elevation above the heart 
nl ICP < 10mmHg
CBF is directly proportional  to CMRO2
CPP= MAP – ICP (or CVP whichever is higher)
nl CPP = 80 – 100 mmHg

CMRO2  by 7% for each 1 C in Temp

O2 basal metabolic rate in an adult: 3cc/kg/min  x 80kg=240cc O2/min

All volatile anesthetics impair CBF autoregulation (un-coupling effect), while IV agents allow
autoregulation to remain intact

CBF is autoregulated and is dependent on PaO2, PaCO2, PP, metabolic demand (CMRO2
causes CBF and is  GCS)
( neurogenic factos, blood viscosity, Temp, positioning (Trendenburg  jugular venous Pr
venous drainage   CBF ,vs. head up position does opposite)