The effect of skull-pin insertion on cerebrospinal fluid pressure and cerebral perfusion pressure: influence of sufentanil and fentanyl

Anesthesia and Analgesia
S JamaliC Ecoffey

Abstract

This randomized prospective study measured the effects of an intravenous opioid bolus on cerebrospinal fluid pressure (CSFP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) during skull-pin insertion. Twenty-two adult patients scheduled for elective craniotomy for supratentorial lesions were studied. Outcome variables were MAP, heart rate (HR), and lumbar CSFP. The standardized anesthetic regimen included fentanyl (2 microg/kg), thiopental (5-7 mg/kg), lidocaine (1.5 mg/kg), isoflurane (0.3-0.7 minimum alveolar anesthetic concentration), and vecuronium (0.1 mg/kg). During stable anesthesia, sufentanil (0.8 microg/kg) or fentanyl (4.5 microg/kg) was given as a bolus before skull-pin insertion. The hemodynamic effects of the opioid injection were modified with phenylephrine and/or atropine when indicated. CSFP remained unchanged in both treatment groups. MAP and CPP increased approximately 10 mm Hg after skull-pin insertion (P<0.001). In the sufentanil group, HR decreased approximately 10 bpm after opioid injection and remained decreased throughout the study. In fentanyl-treated patients, HR decreased 8 bpm after opioid injection but returned to preopioid rates after skull-pin insertion. In conclusion, in ane...Continue Reading

References

May 1, 1979·Anesthesia and Analgesia·P S Colley, R Dunn
May 1, 1989·Acta Anaesthesiologica Scandinavica·R LevinL Vavruch
Jan 1, 1995·Journal of Neurosurgical Anesthesiology·C HörmannA Benzer

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Citations

Jun 1, 2005·Annales Françaises D'anesthèsie Et De Rèanimation·N BruderA de Kersaint-Gilly
Aug 4, 1999·The Journal of Emergency Medicine·P MarikG L Sternbach
Jan 26, 2011·Clinical Medicine & Research·Ayse MizrakUnsal Oner
May 19, 2010·Journal of Neurosurgical Anesthesiology·Satyajeet MisraNilay Chatterjee

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