Neuroanaesthesia and Anaesthesia for Neurosurgery MCQs

Anaesthesia · 20 free questions with answers & explanations.

1. A patient is undergoing craniotomy for a supratentorial glioma. Intraoperatively, the ICP rises to 28 mmHg. Which of the following interventions reduces ICP by decreasing cerebral metabolic rate of oxygen (CMRO2) AND causing cerebral vasoconstriction?
2. During surgery for an intracranial aneurysm, temporary clip occlusion is planned for up to 20 minutes. Which pharmacological strategy provides the BEST cerebral protection during this period of focal ischaemia?
3. A patient is positioned in the sitting (beach chair) position for posterior fossa surgery. Which complication is MOST specific to this position and requires direct intraoperative monitoring?
4. Which inhalational anaesthetic agent is MOST appropriate for neuroanaesthesia requiring maintenance of cerebral autoregulation and lowest increase in ICP at equipotent doses?
5. Following a subarachnoid haemorrhage, cerebral vasospasm is MOST likely to occur during which time window after the initial bleed?
6. A patient with raised ICP (ICP 28 mmHg, MAP 80 mmHg) is posted for craniotomy for a large cerebral tumour. The cerebral perfusion pressure (CPP) is 52 mmHg. What is the TARGET CPP range in neurocritical care to prevent secondary brain injury?
7. During posterior fossa surgery in the sitting position, what is the MOST serious feared complication and how is it best monitored?
8. Hyperventilation to PaCO2 of 30 mmHg is occasionally used as a temporising measure in acute intracranial hypertension. Its mechanism of ICP reduction and its limitation are:
9. Total intravenous anaesthesia (TIVA) is preferred over volatile agent-based anaesthesia for awake craniotomy. Which SPECIFIC intraoperative period requires the patient to be awake and cooperative in this procedure?
10. During clipping of a cerebral aneurysm, the surgeon requests a period of deliberate temporary vascular occlusion. Which pharmacological agent can be used for cerebral protection during this occlusion period?
11. During craniotomy for a supratentorial tumour, which anaesthetic technique most reliably reduces intracranial pressure (ICP) while maintaining cerebral perfusion pressure (CPP)?
12. A patient is positioned in the sitting (beach chair) position for posterior fossa surgery. Which unique complication is the MOST dangerous and requires specific monitoring?
13. Cerebral perfusion pressure (CPP) = MAP − ICP. In a patient with ICP = 35 mmHg and MAP = 75 mmHg, what is CPP and what pharmacological intervention best improves it without raising ICP?
14. Awake craniotomy (asleep-awake-asleep technique) is performed for tumour resection in eloquent cortex. Which anaesthetic combination is ideal for the awake phase to ensure patient cooperation while providing adequate analgesia?
15. Which inhalational agent is ABSOLUTELY contraindicated in patients requiring electroencephalographic (EEG) monitoring and neuroelectrophysiological intraoperative monitoring during spinal cord surgery?
16. A neurosurgeon plans resection of an arteriovenous malformation (AVM) in the eloquent cortex under general anaesthesia with neurophysiological monitoring (motor-evoked potentials, MEPs). Which anaesthetic agent combination is MOST compatible with reliable intraoperative MEP monitoring?
17. During posterior fossa surgery in the sitting position, the anaesthetist notices a sudden decrease in end-tidal CO2 (ETCO2) from 35 to 22 mmHg, with a mill-wheel murmur on precordial Doppler. What is the MOST appropriate immediate management?
18. A patient with a traumatic brain injury (GCS 8) has an ICP of 28 mmHg. The CPP (MAP 75 mmHg) is 47 mmHg. Which osmotic agent is preferred for acute ICP reduction and WHY?
19. Cerebral autoregulation maintains constant CBF over a MAP range of approximately:
20. Intraoperative electrocorticography during awake craniotomy reveals continuous epileptiform discharges after cortical stimulation mapping. The MOST appropriate pharmacological intervention that provides rapid seizure termination without compromising cortical mapping in the immediate window is: