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[Opioids, cerebral circulation and intracranial pressure]
W Schregel1, W Weyerer, G Cunitz
1Klinik für Anaesthesie und operative Intensivtherapie, Knappschaftskrankenhaus, Ruhr-Universität Bochum RUB.
Der Anaesthesist
|July 1, 1994
Summary
Opioids like alfentanil, fentanyl, and sufentanil can affect cerebral blood flow and intracranial pressure. While generally beneficial for brain conditions, careful monitoring is crucial due to potential side effects.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Neuroscience
- Pharmacology
Context:
- Recent publications discuss the impact of alfentanil, fentanyl, and sufentanil on cerebral blood flow (CBF) and intracranial pressure (ICP).
- Understanding these effects is crucial for managing patients with intracranial diseases.
Purpose:
- To review and analyze studies on the effects of alfentanil, fentanyl, and sufentanil on CBF and ICP in various patient populations.
- To investigate the clinical relevance and underlying mechanisms of opioid-induced changes in ICP and CBF.
Summary:
- A systematic literature search identified studies categorized by significant increases, no significant alterations, or decreases in ICP and/or CBF.
- Opioid effects on ICP and CBF are variable, influenced by factors like patient condition, MAP, and administration method (bolus vs. infusion).
- In patients with brain injury and elevated ICP, opioids did not exacerbate ICP increases despite MAP decreases, but could reduce cerebral perfusion pressure.
Impact:
- Opioids are often beneficial and not contraindicated for patients with cerebral diseases and compromised intracranial compliance.
- Monitoring of hemodynamic parameters, ICP, and cerebrovenous oxygen saturation is recommended for at-risk patients.
- Opioids should be administered cautiously in stable hemodynamic situations, preferably via continuous, well-titrated infusions.