Comparative Studies of Therapeutic Measures to Reduce Subdural Intracranial Pressure During Craniotomy
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The level of ICP is of importance in the surgical management of space-occupying cerebral lesions. For many years hyperventilation-induced reduction of cerebral blood volume and mannitol treatment based on osmotic withdrawal of brain tissue water have been used to reduce dural tension before opening of dura mater. Other therapeutic measures to reduce ICP during craniotomy include intravenous administration of indomethacin, placing the patient in the reverse Trendelenburg position and decompression by puncture of cystic tumours. In this chapter three studies are presented. The ICP-reducing effects of hyperventilation, 10 degrees reverse Trendelenburg position, mannitol treatment, indomethacin or surgical decompression in patients subjected to craniotomy in the supine and prone positions in either propofol-fentanyl or propofol-remifentanil anaesthesia are discussed.
KeywordsIntracranial Hypertension Cerebral Blood Volume Surgical Decompression Cerebral Tumour Significant Intergroup Difference
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