Edward Fohrman | Introduction to Neuroanesthesia
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The document provides an overview of neuroanesthesia, detailing the regulation of cerebral blood flow (CBF) and normal cerebral physiology, including CBF values for different brain regions and parameters like intracranial pressure (ICP) and cerebral metabolic rate. It outlines a 'tight brain checklist' to assess factors impacting CBF, such as jugular venous pressure, airway pressures, metabolic rate, potential vasodilators, and mass lesions. This checklist is crucial for managing cerebral conditions during anesthesia.
Edward Fohrman | Introduction to Neuroanesthesia
- 1. Introduction to Neuroanesthesia Edward B. Fohrman M.D. Department of Anesthesiology
- 3. Regulation of Cerebral Blood Flow
- 4. Normal Cerebral Physiology CBF – Global 45–55 mL/100 g/min – Cortical (mostly gray matter)75–80 mL/100 g/min – Subcortical (mostly white matter)∼20 mL/100 g/min CMRO2 = 3 - 3.5 mL/100 g/min CVR = 1.5–2.1 mmHg/100 g/min/mL Cerebral venous PO2 32 – 44 mmHg Cerebral venous SPO2 55%–70% ICP (supine) 8–12 mmHg
- 5. Tight Brain Checklist 1. Are the relevant pressures controlled? – Jugular venous pressure (CVP) Extreme head rotation or neck flexion? Direct jugular compression? Head-up posture? – Airway pressure: Airway obstruction? Bronchospasm? Straining coughing adequately relaxed? Pneumothorax? – Partial pressure of CO2 and O2 (PaCO2, PaO2) – Mean arterial pressure (MAP) 2. Is the metabolic rate (CMRO2) controlled? – Pain/arousal? – Seizures? – Fever? – Consider burst supression 3. Are any potential vasodilators in use? – N2O – volatile anesthetics – NTP – CCB’s 4. Are there any unrecognized mass lesions? – Blood, air ± N2O