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Effect of a Bolus Dose of an Analgetic on Subdural Intracranial Pressure and Cerebral Haemodynamics During General Anaesthesia for Craniotomy in Patients with Supratentorial Cerebral Tumours

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Monitoring of Cerebral and Spinal Haemodynamics During Neurosurgery

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Abstract

Many studies regarding the effects of synthetic opioids on ICP, arteriovenous oxygen difference, mean arterial blood pressure and the CO2 reactivity have been carried out. Contradictory results have been obtained. This, however, is most likely due to different study designs and to different patient populations studied. The overall result seems to be that these opioids depress the blood pressure in a dose-related way. This blood pressure decrease may affect the cerebral parameters depending on whether cerebral autoregulation is intact or not. In this chapter three studies regarding analgetic boluses and the influence on the cerebral haemodynamics are presented. A bolus dose of alfentanil during propofol-fentanyl maintenance, a bolus dose of remifentanil during propofol-remifentanil anaesthesia and a bolus dose of fentanyl during propofol-fentanyl anaesthesia were studied.

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References

  • Ã…keson J, Messeter K, Rosén I et al (1993) Cerebral haemodynamic and electrocortical CO2 reactivity in pigs anaesthetized with fentanyl, nitrous oxide and pancuronium. Acta Anaesthesiol Scand 37:85–91

    PubMed  Google Scholar 

  • Albanese J, Viviand X, Potie F et al (1999) Sufentanil, fentanyl, and alfentanil in head trauma patients: a study on cerebral hemodynamics. Crit Care Med 27:407–411

    Article  PubMed  CAS  Google Scholar 

  • Balakrishnan G, Raudzens P, Samra SK et al (2000) A comparison of remifentanil and fentanyl in patients undergoing surgery for intracranial mass lesions. Anesth Analg 91:163–169

    Article  PubMed  CAS  Google Scholar 

  • Benzer A, Gottardis M, Russigger L et al (1992) Fentanyl increases cerebrospinal fluid pressure in normocapnic volunteers. Eur J Anesthesiol 9:473–477

    CAS  Google Scholar 

  • Coles JP, Leary TS, Monteiro JN et al (2000) Propofol anesthesia for craniotomy: a double- blind comparison of remifentanil, alfentanil, and fentanyl. J Neurosurg Anesthesiol 12:15–20

    Article  PubMed  CAS  Google Scholar 

  • de Nadal M, Austina A, Sahuquillo J et al (1998) Effects on intracranial pressure of fentanyl in severe head injured patients. Acta Neurochir 71(suppl):10–12

    Google Scholar 

  • de Nadal M, Munar F, Poca MA et al (2000) Cerebral hemodynamic effects of morphine and fentanyl in patients with severe head injury. Anesthesiology 92:11–19

    Article  PubMed  Google Scholar 

  • Endo H, Larsen B, Lassen NA (1977) Regional cerebral blood flow alterations remote from the site of intracranial tumours. J Neurosurg 46:271–281

    PubMed  CAS  Google Scholar 

  • Enevoldsen EM, Cold GE, Jensen FT (1976) Dynamic changes in regional CBF, intraventricular pressure, CSF-pH and lactate levels during the acute phase of head injury. J Neurosurg 44:191–214

    PubMed  CAS  Google Scholar 

  • Engelhard K, Reeker W, Kochs E et al (2004) Effect of remifentanil on intracranial pressure and cerebral blood flow velocity in patients with head trauma. Acta Anaesthesiol Scand 48:396–399

    Article  PubMed  CAS  Google Scholar 

  • Fieschi C, Battistini N, Beduschi A et al (1974) Regional cerebral blood flow and intraventricular pressure in acute head injuries. J Neurol Neurosurg Psychiatry 37:1378–1388

    PubMed  CAS  Google Scholar 

  • Freeman J, Ingvar DH (1967) Effects of fentanyl on cerebral cortical blood flow and EEG in the cat. Acta Anaesthesiol Scand 11:381–391

    PubMed  CAS  Google Scholar 

  • Guy J, Hindman BJ, Baker KZ et al (1997) Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions. Anesthesiology 86:514–524

    Article  PubMed  CAS  Google Scholar 

  • Hanowell LH, Thurston JD, Behrman KH et al (1993) Alfentanil administered prior to endotracheal suctioning reduces cerebral perfusion pressure. J Neurosurg Anesthesiol 5:31–35

    PubMed  CAS  Google Scholar 

  • Harrison JM, Girling KJ, Mahajan RP (1999) Effects of target-controlled infusion of propofol on the transient hyperaemic response and carbon dioxide reactivity in the middle cerebral artery. Br J Anaesth 83:839–844

    PubMed  CAS  Google Scholar 

  • Hindman B, Warner D, Todd M et al (1994) ICP and CPP effects of remifentanil and alfentanil. J Neurosurg Anesthesiol 6:304

    Google Scholar 

  • Hung OR, Hope CE, Laney G et al (1992) The effect of alfentanil on intracranial dynamics and hemodynamics in patients with brain tumours undergoing craniotomy. Can J Anesth A4

    Google Scholar 

  • Jung R, Shah N, Reinsel R et al (1990) Cerebrospinal fluid pressure in patients with brain tumours: impact of fentanyl versus alfentanil during nitrous oxide-oxygen anesthesia. Anesth Analg 71:419–422

    Article  PubMed  CAS  Google Scholar 

  • Jünger EC, Newell DW, Grant GA et al (1997) Cerebral autoregulation following minor head injury. J Neurosurg 86:425–432

    PubMed  Google Scholar 

  • Kolbitsch C, Hörmann C, Schmidauer C et al (1997) Hypocapnia reverses the fentanyl-induced increase in cerebral blood flow velocity in awake humans. J Neurosurg Anesthesiol 9:313–315

    Article  PubMed  CAS  Google Scholar 

  • Knüttgen D, Doehn M, Eymer D et al (1989) Hirndrucksteigerung nach fentanyl. Anaesthesist 38:73–75

    PubMed  Google Scholar 

  • Lorenz IH, Kolbitsch C, Schocke M et al (2000). Low-dose remifentanil increases regional cerebral blood flow and regional cerebral blood volume, but decreases regional mean transit time and regional cerebrovascular resistance in volunteers. Br J Anaesth 85:199–204

    Article  PubMed  CAS  Google Scholar 

  • Lorenz IH, Kolbitsch C, Hörmann C et al (2002) The influence of nitrous oxide and remifentanil on cerebral hemodynamics in conscious human volunteers. Neuroimage 17:1056–1064

    Article  PubMed  Google Scholar 

  • Markovitz PB, Cohen DE, Duhaime A et al (1990) Effects of alfentanil in intracranial pressure in children undergoing ventriculo-periodoneal shunt revision. Anesthesiology 73:A213

    Google Scholar 

  • Marx W, Shah N, Long C et al (1989) Sufentanil, alfentanil, and fentanyl: impact on cerebrospinal fluid pressure in patients with brain tumours. J Neurosurg Anesthesiol 1:3–7

    Article  PubMed  CAS  Google Scholar 

  • Matta BF, Heath KJ, Tipping K et al (1999) Direct cerebral vasodilatory effects of sevoflurane and isoflurane. Anesthesiology 91:677–680

    Article  PubMed  CAS  Google Scholar 

  • Mayberg TS, Lam AM, Eng CC et al (1993) The effect of alfentanil on cerebral blood flow velocity and intracranial pressure during isoflurane-nitrous oxide anesthesia in humans. Anesthesiology 78:288–294

    Article  PubMed  CAS  Google Scholar 

  • McPherson RW, Johnson RM, Traystman RJ (1982) The effects of alfentanil on the cerebral vasculature. Anesthesiology 57:A354

    Article  Google Scholar 

  • Michenfelder JD, Theye RA (1971) Effects of fentanyl, droperidol, and Innovar on canine cerebral metabolism and blood flow. Br J Anaesth 43:630–636

    Article  PubMed  CAS  Google Scholar 

  • Milde LN, Milde JH, Gallagher WJ (1989) Cerebral effects of fentanyl in dogs. Br J Anaesth 63:710–715

    Article  PubMed  CAS  Google Scholar 

  • Miller R, Tausk HC, Stark DCC (1975) Effect of Innovar, fentanyl and droperidol on the cerebrospinal fluid pressure in neurosurgical patients. Can Anaesth Soc J 22:502–508

    Article  PubMed  CAS  Google Scholar 

  • Moss E (1992) Alfentanil increases intracranial pressure when intracranial compliance is low. Anaesthesia 47:134–136

    Article  PubMed  CAS  Google Scholar 

  • Moss E, Powell D, Gibson RM et al (1978) Effects of fentanyl on intracranial pressure and cerebral perfusion pressure during hypocapnia. Br J Anaesth 50:779–784

    Article  PubMed  CAS  Google Scholar 

  • Muizelaar JP, Ward JD, Marmarou A (1989) Cerebral blood flow and metabolism in severely head-injured children. Part 2: autoregulation. J Neurosurg 71:72–76

    PubMed  CAS  Google Scholar 

  • Nilsson E, Ingvar DH (1965) Cerebral blood flow during neuroleptanalgesia in the cat. Acta Anaesth Scand 10:47–54

    Google Scholar 

  • Olsen KS, Juul N, Cold GE (2005) Effect of alfentanil on intracranial pressure during propofol-fentanyl anesthesia for craniotomy. A randomized prospective dose-response study. Acta Anaesthesiol Scand 49:445–452

    Article  PubMed  CAS  Google Scholar 

  • Palvölgyi R (1969) Regional cerebral blood flow in patients with intracranial tumours. J Neurosurg 31:149–163

    PubMed  Google Scholar 

  • Paris A, Scholz J, von Knobelsdorff G et al (1998) The effect of remifentanil on cerebral blood flow velocity. Anesth Analg 87:569–573

    Article  PubMed  CAS  Google Scholar 

  • Rosner MJ, Coley IB (1986) Cerebral perfusion pressure, intracranial pressure, and head elevation. J Neurosurg 65:636–641

    PubMed  CAS  Google Scholar 

  • Schregel W, Schäfermeyer H, Müller C et al (1992) Einfluss von halothan, alfentanil und propofol auf der flussgeschwindigkeiten, „gefässquerschnitt“ und „volumenfluss“ in der a. cerebri media. Anaesthesist 41:21–26

    PubMed  CAS  Google Scholar 

  • Strebel S, Lam AM, Matta B et al (1995) Dynamic and static cerebral autoregulation during isoflurane, desflurane and propofol anesthesia. Anesthesiology 83:66–76

    Article  PubMed  CAS  Google Scholar 

  • Summors AC, Gupta AK, Matta BF (1999) Dynamic cerebral autoregulation during sevoflurane anesthesia: a comparison with isoflurane. Anesth Analg 88:341–345

    Article  PubMed  CAS  Google Scholar 

  • Trindle MR, Dodson BA, Rampil IJ (1993) Effects of fentanyl versus sufentanil in equianesthetic doses on middle cerebral artery blood flow velocity. Anesthesiology 78:454–460

    Article  PubMed  CAS  Google Scholar 

  • Wagner KJ, Willoch F, Kochs EF et al (2001) Dose-dependent regional cerebral blood flow changes during remifentanil infusion in humans. Anesthesiology 94:732–739

    Article  PubMed  CAS  Google Scholar 

  • Warner DS, Hindman BJ, Todd MM et al (1996) Intracranial pressure and hemodynamic effects of remifentanil versus alfentanil in patients undergoing supratentorial craniotomy. Anesth Analg 83:348–353

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, Glostrup University Hospital, University of Copenhagen, 2600, Glostrup, Denmark

    Karsten Skovgaard Olsen

  2. Hojkolvej 2, 8210, Aarhus V, Denmark

    Georg E. Cold

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  1. Karsten Skovgaard Olsen
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  2. Georg E. Cold
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Editor information

Editors and Affiliations

  1. Hojkolvej 2, 8210, Aarhus V, Denmark

    Georg E. Cold

  2. Department of Neuroanaesthesia, Aarhus University Hospital, Norrebrogade 44, 8000, Aarhus C, Denmark

    Niels Juul

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© 2008 Springer-Verlag Berlin Heidelberg

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Olsen, K., Cold, G. (2008). Effect of a Bolus Dose of an Analgetic on Subdural Intracranial Pressure and Cerebral Haemodynamics During General Anaesthesia for Craniotomy in Patients with Supratentorial Cerebral Tumours. In: Cold, G., Juul, N. (eds) Monitoring of Cerebral and Spinal Haemodynamics During Neurosurgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-77873-8_13

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  • DOI: https://doi.org/10.1007/978-3-540-77873-8_13

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-77872-1

  • Online ISBN: 978-3-540-77873-8

  • eBook Packages: MedicineMedicine (R0)

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