Children with TBI often have altered cerebral hemodynamics. These patients
may present following unintentional trauma or as victims of intentional trauma.
They may require anesthesia for neurosurgical procedures immediately after
presentation. Which of the following statements is INCORRECT?
a) Increased CMRO2 caused by seizures may be controlled with muscle paralysis
b) Cerebral perfusion may be best maintained by ensuring a CPP of at least 40
mmHg
c) Narcotic use should be avoided if mechanical ventilation is not anticipated
d) Sustained ICP above 20 mmHg is associated with poor outcomes
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Answer
Answer a. Muscle paralysis will stop the physical appearance of a convulsion but
will not terminate seizure activity of the brain, and therefore should never be
used to treat a seizure. When intubation is required for airway protection and
neuromuscular blockade is necessary, an adequate amount of anti-epileptic drug
should be first administered to ensure ongoing occult seizure activity does not
occur.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.
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