Effects of fentanyl, sufentanil, and alfentanil on brain retractor pressure

Sufentanil and alfentanil have been reported to increase cerebral blood flow and intracranial pressure. Agents producing these effects may adversely affect the relationship between brain retractors and underlying cerebral tissues during craniotomy, potentially predisposing the patient to brain retractor injury. The effects of fentanyl, sufentanil, alfentanil, and a placebo (saline) on brain retractor pressure were therefore evaluated prospectively in 24 adults undergoing elective craniotomy. None of these narcotics significantly affected brain retractor pressure. Each significantly and similarly decreased arterial pressure and cerebral perfusion pressure. If these narcotics are administered in doses that avoid adverse hemodynamic changes that could compromise cerebral tissues indirectly, each of the narcotics studied appears safe for intraoperative administration once the cranium is open.