[Post-operative blood pressure management by nitroglycerin in the field of neurosurgery]

It is well known that vasodilating antihypertensive drugs induce intracranial hypertension. A considerable number of papers have reported nitroglycerin-induced ICP elevation during anesthetized operations. However, except for Gagnon's report, most papers dealt with normal patients. Our study, using an extradural pressure transducer clinically, deals with the nitroglycerin drip infusion and its effect on high ICP state. Mean ICP value before infusion was 42 mmHg+ 14.8 (N = 10). Three cases out of ten showed ICP elevation corresponding with blood pressure depression. Six cases out of ten revealed ICP depression corresponding with blood pressure depression. One case did not show any difference in ICP. There was a statistically significant difference between the ICP elevated group and the depressed group. These results suggest that very high ICP state, like vasomotor paralysis, does not have a potential to open the vascular bed in the cranium and blood pressure depression induced by nitroglycerin infusion causes ICP depression. We would like to conclude that nitroglycerin can be used for postoperative blood pressure control even in the neurosurgical field.