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Intracranial pressure during nitroglycerin-induced hypotension
Journal of Neurosurgery
|September 1, 1980
Summary
Intravenous nitroglycerin administration during craniotomy unexpectedly increased intracranial pressure (ICP) in patients. This rise in ICP, despite a drop in mean arterial pressure (MAP), reduced cerebral perfusion pressure.
Area of Science:
- Neurosurgery
- Anesthesiology
- Pharmacology
Background:
- Nitroglycerin is used to achieve a bloodless surgical field during craniotomy.
- The effects of nitroglycerin on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) are not fully understood.
Purpose of the Study:
- To investigate the impact of intravenous nitroglycerin on ICP and MAP during craniotomy.
- To assess the effect of nitroglycerin on CPP in patients undergoing neurosurgery.
Main Methods:
- Five anesthetized and hyperventilated patients undergoing craniotomy received intravenous nitroglycerin.
- Intracranial pressure (ICP) was monitored using a subarachnoid screw.
- Mean arterial pressure (MAP) was monitored via an indwelling radial artery catheter.
Main Results:
- Mean arterial pressure (MAP) decreased significantly from 100.4 to 69.0 torr.
- Intracranial pressure (ICP) increased significantly from 14.2 to 30.8 torr.
- Cerebral perfusion pressure (CPP) decreased from 90.2 to 38.2 torr (p < 0.0005).
Conclusions:
- Intravenous nitroglycerin administration during craniotomy can lead to a significant increase in intracranial pressure (ICP).
- This increase in ICP is likely due to vasodilation of capacitance vessels, leading to increased cerebral blood volume in the noncompliant cranial cavity.
- The reduction in CPP necessitates careful consideration of nitroglycerin use in neurosurgical patients.