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Subdural Intracranial Pressure and Cerebral Haemodynamics During General Anaesthesia for Craniotomy in Patients with Cerebral Aneurysm

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Monitoring of Cerebral and Spinal Haemodynamics During Neurosurgery

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Abstract

Patients with cerebral aneurisms are frequently presented to the neuroanaesthesiologist, although the number is decreasing due to intravascular coiling. In the intensive care setting a significant correlation between ICP and Hunt & Hess gradation has been described in patients with subarachnoid haemorrhage. The relationship between H&H gradation and perioperative ICP is an important issue because measures to decrease ICP may prevent brain swelling and improve surgical access. It therefore seems reasonable to investigate this issue, taking both patient positioning and anaesthetic technique into consideration. In this chapter two studies are presented. In the first study we investigated the subdural ICP and cerebral perfusion pressure in patients with cerebral aneurysm anaesthetized with either propofol-fentanyl or isoflurane- fentanyl. In the second study the effect of 10 degrees reverse Trendelenburg position on subdural ICP and cerebral perfusion pressure in patients subjected to craniotomy for cerebral aneurysm were investigated.

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References

  • Albeck MJ, Børgesen SE, Gjerris F et al (1991) Intracranial pressure and cerebrospinal fluid outflow conductance in healthy subjects. J Neurosurg 74:597–600

    PubMed  CAS  Google Scholar 

  • Algotsson L, Messeter K, Nordström CH et al (1988) Cerebral blood flow and oxygen consumption during isoflurane and halothane anaesthesia in man. Acta Anaestheiol Scand 32:15–20

    CAS  Google Scholar 

  • Archer DP, Labrecque P, Tylor JL et al (1987) Cerebral blood volume is increased in dogs during administration of nitrous oxide or isoflurane. Anesthesiology 67:642–648

    Article  PubMed  CAS  Google Scholar 

  • Artru AA, Shapira Y, Bowdle A (1992) Electroencephalogram, cerebral metabolism, and vascular responses to propofol anesthesia in dogs. J Neurosurg Anesthesiol 4:99–109

    Article  PubMed  CAS  Google Scholar 

  • Auer LM, Mokry M (1990) Disturbed cerebrospinal fluid circulation after subarachnoid hemorrhage and acute aneurysm surgery. Neurosurgery 26:804–808

    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 

  • Bundgaard H, Landsfeldt U, Cold GE (1998) Subdural monitoring of ICP during craniotomy: thresholds of cerebral swelling/herniation. Acta Neurochir Suppl 71:276–278

    PubMed  CAS  Google Scholar 

  • Cenic A, Craen RA, Lee TY (2002) Cerebral blood volume and blood flow responses to hyperventilation in brain tumours during isoflurane or propofol anesthesia. Anesth Analg 94:661–666

    Article  PubMed  CAS  Google Scholar 

  • Cucchiara RF, Theye RA, Michenfelder JD (1974) The effects of isoflurane on canine cerebral metabolism and blood flow. Anesthesiology 40:571–574

    Article  PubMed  CAS  Google Scholar 

  • Durward QJ, Amacher AL, Del Maestro RF et al (1983) Cerebral and cardiovascular responses to changes in head elevation in patients with intracranial hypertension. J Neurosurg 59:938–944

    PubMed  CAS  Google Scholar 

  • Eintrei C, Leszniewski W, Carlsson C (1985) Local application of 133-Xenon for measurement of regional cerebral blood flow (rCBF) during halothane, enflurane and isoflurane anaesthesia in humans. Anesthesiology 63:391–394

    Article  PubMed  CAS  Google Scholar 

  • Feldman Z, Kanter MJ, Robertson CS et al (1992) Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients. J Neurosurg 76:207–211

    PubMed  CAS  Google Scholar 

  • Gelman S, Fowler KC, Smith LR (1984) Regional blood flow during isoflurane and halothane anaesthesia. Anesth Analg 63:557–565

    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 

  • Hartmann A (1980) Continuous monitoring of CSF pressure in acute subarachnoid hemorrhage. In: Shulman K, Marmarau A, Miller JD, Becker DP, Hochwald GM, Brock M (eds) Intracranial pressure IV. Springer, Berlin, pp 220–228

    Google Scholar 

  • Hase U, Reulen HJ, Fenske A et al (1978) Intracranial pressure and pressure volume relation in patients with subarachnoid haemorrhage (SAH). Acta Neurochir 44:69–80

    Article  CAS  Google Scholar 

  • Hauerberg J, Juhler M, Rasmussen G (1993) Cerebral blood flow autoregulation after experimental subarachnoid hemorrhage during hyperventilation in rats. J Neurosurg Anesthesiol 5:258–263

    PubMed  CAS  Google Scholar 

  • Haure P, Cold GE, Hansen TM et al (2003) The ICP-lowering effect of 10 degrees reverse Trendelenburg position during craniotomy is stable during a 10-minute period. J Neurosurg Anesthesiol 15:297–301

    Article  PubMed  Google Scholar 

  • Hayashi M, Marukawa S, Fujii H et al (1977) Intracranial hypertension in patients with ruptured aneurysm. J Neurosurg 46:584–590

    Article  PubMed  CAS  Google Scholar 

  • Langfitt TW, Weinstein JD, Kassell NF et al (1964) Transmission of increased intracranial pressure. I. Within the craniospinal axis. J Neurosurg 21:989–997

    PubMed  CAS  Google Scholar 

  • Lovell AT, Marshall AC, Elwell CE et al (2000) Changes in cerebral blood volume with changes in position in awake and anesthetized subjects. Anesth Analg 90:372–376

    Article  PubMed  CAS  Google Scholar 

  • Ma X-D, Willumsen L, Hauerberg J et al (2000) Effects of graded hyperventilation on cerebral blood flow autoregulation in experimental subarachnoid hemorrhage. J Cereb Blood Flow Metab 20:718–725

    PubMed  CAS  Google Scholar 

  • Madsen JB (1991) Changes in CBF and CMRO2 in patients undergoing craniotomy with propofol infusion. In: Prys-Roberts C (ed) Focus on infusion. Current Medical Literature pp 162–164

    Google Scholar 

  • Madsen JB, Cold GE, Hansen ES et al (1987) The effect of isoflurane on cerebral blood flow and metabolism in humans during craniotomy for small supratentorial cerebral tumours. Anesthesiology 66:332–336

    Article  PubMed  CAS  Google Scholar 

  • Meixensberger J, Baunach S, Amschler J et al (1997) Influence of body position on tissue-pO2, cerebral perfusion pressure and intracranial pressure in patients with acute brain injury. Neurol Res 19:249–253

    PubMed  CAS  Google Scholar 

  • Moraine JJ, Berre J, Melot C (2000) Is cerebral perfusion pressure a major determinant of cerebral blood flow during head elevation in comatose patients with severe intracranial lesions? J Neurosurg 92:606–614

    PubMed  CAS  Google Scholar 

  • Murkin JM, Farrar JK, Tweed WA et al (1986) Cerebral blood flow, oxygen consumption and EEG during isoflurane anesthesia. Anest Analg 65:S107

    Article  Google Scholar 

  • Murphy FL, Kennell EM, Johnstone RE et al (1974) The effects of enflurane, isoflurane and halothane on cerebral blood flow and metabolism in man. Abstracts and scientific papers. Annual meeting of the Am Soc Anaesth, pp 61–62

    Google Scholar 

  • Newberg LA, Michenfelder JD (1983) Cerebral protection by isoflurane during hypoxemia or ischemia. Anesthesiology 59:29–35

    PubMed  CAS  Google Scholar 

  • Olsen KS, Henriksen L, Owen-Falkenberg A et al (1994) Effect of 1 or 2 MAC isoflurane with or without ketanserin on cerebral blood flow autoregulation in man. Br J Anaesth 72:66–71

    Article  PubMed  CAS  Google Scholar 

  • Ostapkovich ND, Baker KZ, Fogarty-Mack P et al (1998) Cerebral blood flow and CO2 reactivity is similar during remifentanil/N2O and fentanyl/N2O anesthesia. Anesthesiology 89:358–363

    Article  PubMed  CAS  Google Scholar 

  • Petersen KD, Landsfeldt U, Cold GE et al (2003) Intracranial pressure and cerebral hemodynamic in patients with cerebral tumours. A randomized prospective study of patients subjected to craniotomy in propofol-fentanyl, isoflurane-fentanyl, or sevoflurane-fentanyl anesthesia. Anesthesiology 98:329–336

    Article  PubMed  CAS  Google Scholar 

  • Ramani R, Todd MM, Warner DS (1992) A dose-response study of the influence of propofol on cerebral blood flow, metabolism and the electroencephalogram in the rabbit. J Neurosurg Anesthesiol 4:110–119

    Article  PubMed  CAS  Google Scholar 

  • Rasmussen M, Bundgaard H, Cold GE (2004) Craniotomy for supratentorial brain tumours: risk factors for brain swelling after opening of dura mater. J Neurosurg 101:621–626

    PubMed  Google Scholar 

  • Rolighed Larsen JK, Haure P, Col GE (2002) Reverse Trendelenburg position reduces intracranial pressure during craniotomy. J Neurosurg Anesthesiol 14:16–21

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  • Schneider GH, von Helden GH, Franke R et al (1993) Influence of body position on jugular venous oxygen saturation, intracranial pressure and cerebral perfusion pressure. Acta Neurochir Suppl 59:107–112

    CAS  Google Scholar 

  • Stephan H, Sonntag H, Schenk HD et al (1987) Effect of Disoprivan (propofol) on the circulation and oxygen consumption of the brain and CO2 reactivity of brain vessels in the human. Anaesthesist 36:60–65

    PubMed  CAS  Google Scholar 

  • Stephan H, Sonntag H, Seyde WC et al (1988) Energie-und Aminosäurenstoffwechsel des Menschlichen Gehirns unter Desoprivan und verschiedenen paCO2-Werten. Anaesthesist 37:297–304

    PubMed  CAS  Google Scholar 

  • Stilling M, Karatasi E, Rasmussen M et al (2005) Subdural intracranial pressure, cerebral perfusion pressure, and the degree of cerebral swelling in supra- and infratentorial space-occupying lesions in children. Acta Neurochir Suppl 95:133–136

    PubMed  CAS  Google Scholar 

  • Stullken AH, Milde JH, Michenfelder JD (1977) The nonlinear responses of cerebral metabolism to low concentrations of halothane, enflurane, isoflurane and thiopental. Anesthesiology 46:28–34

    Article  PubMed  CAS  Google Scholar 

  • Tankisi A, Rolighed Larsen J, Rasmussen M et al (2002) The effects of 10 degrees reverse Trendelenburg position on ICP and CPP in prone positioned patients subjected to craniotomy for occipital or cerebellar tumours. Acta Neurochir 144:665–670

    Article  CAS  Google Scholar 

  • Tankisi A, Rasmussen M, Juul N et al (2006) The effects of 10° reverse Trendelenburg position on subdural intracranial pressure and cerebral perfusion pressure in patients subjected to craniotomy for cerebral aneurysm. J Neurosurg Anesthesiol 18:11–17

    Article  PubMed  Google Scholar 

  • Todd MM, Drummond JC (1984) A comparison of the cerebrovascular and metabolic effects of halothane and isoflurane in the cat. Anesthesiology 60:276–282

    Article  PubMed  CAS  Google Scholar 

  • Todd MM, Weeks J (1996) Comparative effects of propofol, pentobarbital, and isoflurane on cerebral blood flow and blood volume. J Neurosurg Anesthesiol 8:296–303

    Article  PubMed  CAS  Google Scholar 

  • Vandesteene A, Trempont V, Engelman E et al (1988) Effect of propofol on cerebral blood flow and metabolism in man. Anaesthesia 43(suppl):42–43

    Article  PubMed  CAS  Google Scholar 

  • Voldby B, Enevoldsen EM (1982) Intracranial pressure changes following aneurysm rupture. Part 1: clinical and angiographic correlations. J Neurosurg 56:186–196

    PubMed  CAS  Google Scholar 

  • Voldby B, Enevoldsen EM, Jensen FT (1985) Cerebrovascular reactivity in patients with ruptured intracranial aneurysms. J Neurosurg 62:59–67

    PubMed  CAS  Google Scholar 

  • Watts AD, Eliasziw M, Gelb AW (1998) Propofol and hyperventilation for the treatment of increased intracranial pressure in rabbits. Anesth Analg 87:564–568

    Article  PubMed  CAS  Google Scholar 

  • Werner C, Hoffman WE, Kochs E et al (1992) The effects of propofol on cerebral blood flow in correlation to cerebral blood flow velocity in dogs. J Neurosurg Anesthesiol 4:41–46

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neuroanaesthesia, Aarhus University Hospital, Noorebrogade 44, 8000, Aarhus C, Denmark

    Alp Tankisi

  2. Hojkolvej 2, 8210, Aarhus V, Denmark

    Georg E. Cold

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  1. Alp Tankisi
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  2. Georg E. Cold
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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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Tankisi, A., Cold, G. (2008). Subdural Intracranial Pressure and Cerebral Haemodynamics During General Anaesthesia for Craniotomy in Patients with Cerebral Aneurysm. 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_19

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  • DOI: https://doi.org/10.1007/978-3-540-77873-8_19

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-77872-1

  • Online ISBN: 978-3-540-77873-8

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