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The influence of intravenous anaesthetic agents on primarily increased intracranial pressure

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Summary

In the choice of anaesthetics and techniques the danger of a possible progressive increase of intracranial pressure (ICP) should be considered. Therefore the influence of intravenous anaesthetic agents on mean arterial pressure, ICP, and cerebral perfusion pressure (CPP) in patients with primarily increased ICP was observed under standard conditions for 20–40 minutes. Etomidate, thiopentone, propanidid, and ketamine showed remarkable effects on ICP, even in patients with disturbed cerebro-vascular reactivity. Etomidate and thiopentone cause a fall of ICP by 26%. Because of its stabilizing effects on circulation etomidate does not induce a reduction of CPP, whereas thiopentone will do so because of its depressing effect on blood pressure. Propanidid appears to be a less suitable agent when there is raised ICP, because it induces fluctuations of ICP and blood pressure up to the third minute after injection. According to our results, monoanaesthesia with ketamine cannot be recommended when there is increased ICP because it causes a prolonged increase in ICP, and reduction of blood pressure and CPP.

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Author notes

  1. J. Schulte am Esch, G. Pfeifer & I. Thiemig

    Present address: Institute for Anaesthesiology of the University of Bonn, Germany

  2. W. Entzian

    Present address: Neurosurgical Clinic of the University of Bonn, Germany

Authors and Affiliations

  1. Institute for Anaesthesiology of the University of Bonn, Germany

    W. Entzian

  2. Neurosurgical Clinic of the University of Bonn, Germany

    J. Schulte am Esch, G. Pfeifer & I. Thiemig

Authors
  1. J. Schulte am Esch
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  2. G. Pfeifer
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  3. I. Thiemig
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  4. W. Entzian
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Schulte am Esch, J., Pfeifer, G., Thiemig, I. et al. The influence of intravenous anaesthetic agents on primarily increased intracranial pressure. Acta neurochir 45, 15–25 (1978). https://doi.org/10.1007/BF01774380

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