Althesin in neurosurgical patients: effects on cerebral hemodynamics and metabolism

The effect of althesin 0.5 ml/10 kg on arterial blood pressure, intracranial pressure, cerebral blood flow and oxygen uptake was studied on 19 occasions in 16 patients with varied cerebral pathology. Cerebral blood flow (CBF) was measured using the intracarotid 133xenon method and a 35-channel scintillation detector after cannulation of the internal carotid artery, the internal jugular bulb and the lateral cerebral ventricle. Arterial and intracranial pressures were recorded continuously. Blood gas tensions were measured in simultaneously drawn samples from the internal carotid artery and the jugular bulb. Cerebral oxygen uptake was calculated from the product of CBF and arteriovenous oxygen content difference. Control values were obtained with the patients under a basic general anesthesia, consisting of N2O/O2 pancuronium. The effect of a bolus injection of althesin was then studied 1 and 20 min after the injection. A significant reduction in intracranial pressure, cerebral blood flow and metabolism at 1 min was found to have essentially subsided 20 min after the injection. In patients with focal brain damage, regional flow analysis revealed a paradoxical increase in flow after althesin in the areas corresponding to the focus.