Intracranial pressure changes during rapid sequence intubation: a swine model

Area of Science:

• Anesthesiology and Critical Care Medicine
• Neuroscience and Neurocritical Care

Background:

• Intracranial pressure (ICP) changes from rapid sequence intubation (RSI) agents are debated.
• A pilot study developed a swine model to investigate these ICP changes.

Purpose of the Study:

• To investigate the intracranial pressure (ICP) changes associated with different combinations of rapid sequence intubation (RSI) agents.
• To establish a reliable swine model for studying RSI agent effects on ICP.

Main Methods:

• Eight adult swine were instrumented with arterial and intracranial pressure monitors.
• Four sequential RSI regimens were tested: thiopental alone, thiopental with succinylcholine, lidocaine with thiopental and succinylcholine, and pancuronium with lidocaine, thiopental, and succinylcholine.
• ICP and hemodynamic parameters were recorded and analyzed.

Main Results:

• Peak ICP changes occurred 2-3 minutes post-administration of induction agents.
• RSI regimens including paralysis agents (succinylcholine or pancuronium) resulted in significantly higher peak ICP increases (12.0-13.6 mm Hg) compared to thiopental alone (3.6 mm Hg).
• Pretreatment with lidocaine did not demonstrate a significant impact on ICP changes.

Conclusions:

• The developed swine model effectively allows for the examination of aggregate ICP effects of RSI medication combinations.
• RSI regimens incorporating paralysis agents led to threefold increases in peak ICP changes versus sedation-only.
• Future research can explore other agents and simulate head injury physiology by manipulating ICP.