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Opioid sedation does not alter intracranial pressure in head injured patients

Abstract

Purpose

This study aimed to examine the effects of sedative doses of morphine, fentanyl and sufentanil on intracranial pressure (ICP) in head-injured patients in whom changes in mean artenal pressure (MAP) were minimized.

Methods

Fifteen severely head-injured patients (G5C of ≤8) were randomly assigned to receive either fentanyl. sufentanil or morphine, titrating the drug to a maximal 10% decrease in MAP. The patients were subsequently given an infusion of the same opioid. For four hours, ICP MAP and heart rate were recorded. Results: In all groups, there were no increases in ICP. There was a decrease in MAP in the sufentanil group at 10 min (P < 0.05) and 45 min after the initial opioid bolus. These decreases in MAP were not associated with increases in ICP.

Conclusion

The study suggests that when opioids are titrated in head-injured patients, worsening intracranial pressure can be avoided.

Résumé

Objectif

Étudier les effets de doses sédatives de morphine, de fentanyl et de sufentanil sur la pression intracrânienne (PIC) chez des traumatisés du crâne dont la pression artérielle moyenne (RAM) n’avait que légèrement varié.

Méthodes

Quinze graves traumatisés du crâne (Échelle de Glasgow ≤ 8) ont été assignés aléatoirement pour recevoir du fentanyl, du sufentanil, ou de la morphine titrés de façon à abaisser la PAM de 10% ou moins. Les patients ont par la suite reçu une perfusion du même morphinique. Pendant quatre heures, la PIC, la PAM et la fréquence cardiaque étaient enregistrées.

Resultats

La PIC est demeurée inchangée dans tous les groupes. La PAM a baissé dans le groupe sufentanil à la 10e minute (P > 0,05) et a la 45e minute qui ont suivi l’administration du bolus initial. Ces diminutions de la PAM n’étaient pas associées à une augmentation de la PIC.

Conclusion

Cette étude suggère que l’administration titrée de morphiniques à des traumatisés du crâne ne provoque pas de détérioration de la pression intracrânienne.

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Correspondence to Kathryn K Lauer.

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Supported in part by medical research funds from the Department of Veterans Affairs.

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Lauer, K.K., Connolly, L.A. & Schmeling, W.T. Opioid sedation does not alter intracranial pressure in head injured patients. Can J Anaesth 44, 929–933 (1997). https://doi.org/10.1007/BF03011963

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  • DOI: https://doi.org/10.1007/BF03011963

Keywords

  • Morphine
  • Fentanyl
  • Mean Arterial Pressure
  • Intracranial Pressure
  • Sufentanil