Medical Pharmacology: Management of Intracranial Pressure

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Mechanisms responsible for ICP reduction caused by furosemide (Lasix) administration:
1. reduce cerebral edema by enhancing water transport
2. decreasing CSF production
3. systemic diuresis
4. A & C
5. A, B & C
ICP reduction: corticosteroids
1. blood-brain barrier repair
2. preoperative steroid administration may initially worsen neurological status before ICP reduction
3. brain dehydration
4. A & C
5. A, B & C
Drugs which may reduce systemic blood-pressure in patients with elevated ICP but with limited/no effect on CBF or ICP
1. labetalol (Trandate, Normodyne)
2. esmolol (Brevibloc)
3. propranolol (Inderal)
4. A & C
5. A, B & C
Complications of continual perioperative steroid administration:
1. hypoglycemia
2. GI bleeding
3. infection
4. B & C
5. A, B & C
Mainstay of ICP reduction:
1. chlorthalidone (Hygroton)
2. furosemide (Lasix)
3. hyperventilation
Effectiveness in reducing ICP:
1. mannitol (Osmitrol) > furosemide (Lasix)
2. furosemide (Lasix) > mannitol (Osmitrol)
3. both about equal
Most common opioid usedin anesthesia maintenance and patients with supratentorial tumors:
1. meperidine (Demerol)
2. fentanyl (Sublimaze)
3. morphine
4. pentazocine (Talwain)
5. propoxyphene (Darvon)
Succinylcholine (Anectine)-mediated increase in ICP may be blocked by a full, paralyzing vecuronium (Norcuron) dose
1. true
2. false
Induction sequencein patients with elevated ICP: IV thiopental (Pentothal), fentanyl (Sublimaze), muscle relaxant.
1. reasonable
2. unreasonable
Alternative to nitrous oxide or higher isoflurane (Forane) concentrations (> 1%) for patients with high ICP or low intracranial compliance
1. opioid-thiopental (Pentothal)
2. propofol (Diprivan) + midazolam (Versed) or low-dose isoflurane (Forane)
3. both
4. neither
Vasolytic effects may cause an increase in ICP in patients with abnormal autoregulation:
1. doxacurium (Nuromax)
2. pipecuronium (Arduan)
3. vecuronium (Norcuron)
4. roncuronium (Zemuron)
5. pancuronium (Pavulon)
Nondepolarizing muscle relaxants least likely to increase ICP
1. d-tubocurarine
2. metocurine (Metubine Iodide)
3. atracurium (Tracrium)
4. mivacurium (Mivacron)
5. doxacurium (Nuromax)
Hyperventilation and ICP reduction:
1. effective for both subacute and acute management
2. decreases CBF by cerebral vasodilation
3. effectiveness independent of cerebrovascular CO2 reactivity
Relatively rapid ICP reduction:
1. corticosteroids
2. mannitol (Osmitrol)
3. both
4. neither
Succinylcholine (Anectine) and ICP
1. may increase ICP
2. not recommended for elective neurosurgery
3. both
4. neither
Factor(s) which may impair cerebral vascular CO2 responsiveness:
1. cerebral ischemia
2. cerebral trauma
3. tumor presence
4. infection
5. all the above
Succinylcholine (Anectine) should be avoided in hemiplegic/paraplegic patients because:
1. duration of action may be excessive
2. bradycardia may be difficult to manage
3. hyperkalemia may occur
4. renal excretion may be compromised
Best agent for rapid sequence tracheal intubation to achieve total paralysis:
1. pancuronium (Pavulon)
2. atracurium (Tracrium)
3. succinylcholine (Anectine)
4. tubocurarine
Management of elevated ICP: furosemide (Lasix) + mannitol (Osmitrol)
1. more severe electrolyte balance and dehydration
2. more effective than mannitol (Osmitrol) alone in reducing intracranial pressure
3. both
4. neither
Anesthesia in patients with severe intracranial hypertension even after steroids, hyperventilation, and diuretic administration
1. isoflurane (Forane) + nitrous oxide
2. enflurane (Ethrane) + thiopental (Pentothal)
3. thiopental (Pentothal) + fentanyl (Sublimaze) boluses/infusion
Mannitol (Osmitrol) and ICP reduction
1. may cause initial increase in ICP
2. in patients with reduced left ventricular capacity, loop diuretics may be more appropriate for lowering ICP
3. both
4. neither
Most common volatile agent used in anesthesia maintenance in patients with supratentorial tumors
1. enflurane (Ethrane)
2. halothane (Fluothane)
3. isoflurane (Forane)
4. nitrous oxide
Hyperventilation to reduce ICP & therapeutic concerns:
1. PaCO2 < 20 mm Hg: excessive cerebral vasodilation
2. hyperventilation + enflurane (Ethrane): increasing ICP
3. both
4. neither
In management of intracranial hypertension, mannitol (Osmitrol) decreases ICP independent of the status of the blood-brain barrier
1. true
2. false
Combined alpha and data-adrenergic blockade:
1. propranolol (Inderal)
2. esmolol (Brevibloc)
3. labetalol (Trandate, Normodyne)
4. metoprolol (Lopressor)
Intraoperative implications of of combination treatment (furosemide (Lasix) + mannitol (Osmitrol)) for ICP reduction
1. may require potassium replacement
2. requires careful monitoring electrolytes
3. both
4. pewter