Neuromuscular Blocking Agents
In animal experiments succinylcholine increases ICP (Cottrell et al. 1983, Lanier et al. 1986). The increase in ICP is also observed after pre-treatment with thiopentone (Thiagarajah et al. 1988). In dogs subjected to succinylcholine injection, CBF increases within a few minutes and this hyperperfusion is accompanied by EEG activation (Mori et al. 1973, Lanier et al.1986) and an increase in PaCO2 (Hagan et al. 1983). Thus, the increase in CBF and ICP might partly be caused by the metabolic activation and partly by the increase in PaCO2 However, fasciculation in the muscles of the neck, causing stasis in the jugular veins might also be a factor attributing to the increase in ICP (Cottrell et al. 1983). In human studies without (Halldin and Wâhlin 1959, Marx et al. 1962), and with intracranial space-occupying lesions, an increase in ICP has been observed (March et al. 1980, Minton et al. 1986c). In patients scheduled for craniotomy, induction of anaesthesia with thiopentone pancuronium followed by light enflurane anaesthesia allows successful control of ICP, while the use of succinylcholine for intubation gives rise to an increase in ICP (McLeskey et al. 1974).