Conclusions
Neuroleptanalgesic agents may lead to respiratory depression and significant increases in intracranial pressure even when small doses are used. These agents should be used with caution in neurosurgicaJ patients with intracranial lesions undergoing angiography or pneumoencephalography without general anaesthesia. In the presence of a raised intracranial pressure neuroleptanalgesic agents should not be used for premedication or as an adjunct to local anaesthesia.
RéSUMé
On a effectué chez des patients de neurochirurgie des mesures du liquide céphalo-rachidien (L.R.C.) avant et après l’administration d’inovar, dropéridol et fentanyl. Les patients avaient reçu une prémédication légère. Le dropéridol n’affecte pas la dynamique du L.R.C. Les changements observés étaient associés dans le temps avec des changements significatifs de PaO 2 et PaCO 2, indiquant une dépression respiratoire. Ces résultats doivent nous rappeler les dangers liés à une dépression respiratoire chez des patients avec des pressions anormales du L.C.R. Ceci s’applique en particulier aux patients soumis à des études neuroradiologiques. Chez ces malades, de telles augmentations pourraient influencer l’état neurologique. De plus, l’augmentation de la PaCO 2 pourrait modifier le flot sanguin régional et rendre l’interprétation radiologique plus difficile. On oublie malheureusement fréquemment que l’innovar est un mélange de médicaments et l’on ne se préoccupe pas suffisamment de la dépression respiratoire causée par le fentanyl. Si une sédation est requise durant ces procédures, notre étude suggère que le dropéridol seul ne produit pas de modifications importantes.
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Miller, R., Tausk, H.C. & Stark, D.C.C. Effect of innovar, fentanyl and droperidol on the cerebrospinal fluid pressure in neurosurgical patients. Canad. Anaesth. Soc. J. 22, 502–508 (1975). https://doi.org/10.1007/BF03004866
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DOI: https://doi.org/10.1007/BF03004866