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Related Experiment Videos

Cardiovascular changes during endoscopic third ventriculostomy.

J van Aken1, M Struys, T Verplancke

  • 1Department of Anesthesiology, University Hospital, University of Ghent, Belgium. Jozef.Vanaken@ugent.be

Minimally Invasive Neurosurgery : MIN
|September 25, 2003
PubMed
Summary
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Sudden intracranial pressure (ICP) increases during endoscopic third ventriculostomy (ETV) can trigger a Cushing reflex. Early detection of this ICP rise, characterized by hypertension and heart rate changes, is crucial to prevent adverse events.

Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Endoscopic third ventriculostomy (ETV) is a neurosurgical procedure for obstructive hydrocephalus.
  • Sudden increases in intracranial pressure (ICP) can occur during ETV, posing risks to patients.
  • The early detection of ICP elevations and associated physiological responses, like the Cushing reflex, during ETV is not well-documented.

Purpose of the Study:

  • To retrospectively analyze anesthesia charts of patients undergoing ETV to identify early signs of increased ICP.
  • To investigate the occurrence and characteristics of the Cushing reflex during ETV.
  • To highlight the importance of recognizing the Cushing reflex for timely surgical intervention.

Main Methods:

  • Retrospective analysis of anesthesia records from 88 patients with obstructive hydrocephalus who underwent ETV under general anesthesia.

Related Experiment Videos

  • Monitoring of invasive blood pressure, electrocardiogram, end-expired carbon dioxide, pulse oximetry, and heart rate.
  • Evaluation of physiological variables before, during, and after the ETV procedure, focusing on changes related to ICP.

    • Main Results:

    • 67 out of 88 patients had an uneventful ETV procedure.
    • In 6 patients, a Cushing reflex (tachycardia and hypertension followed by bradycardia and hypertension) was observed, indicating a significant ICP increase.
    • The study confirms that both tachycardia and bradycardia are essential components of the Cushing reflex, alongside hypertension.

    Conclusions:

    • The Cushing reflex, characterized by specific hemodynamic changes, can occur during ETV due to increased ICP.
    • Relying solely on persistent bradycardia to alert surgeons to ICP increases during ETV may be dangerously delayed.
    • Prompt recognition of the Cushing reflex during ETV is vital for preventing potentially fatal complications such as asystole.