Edward Fohrman MD is an experienced anesthesiologist who runs Fohrman Anesthesiology. Here he shares his thoughts about neuroanesthesia. Visit EdwardFohrman.com for more.

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