Adrenaline-induced hypotension in neurosurgery

Area of Science:

• Anesthesiology and Surgical Procedures
• Cardiovascular Physiology in Neurosurgery

Background:

• Scalp infiltration is a common technique for local anesthesia and hemostasis in neurosurgical procedures.
• The use of adrenaline (epinephrine) in local anesthetics is debated due to potential cardiovascular effects, especially in patients undergoing cranial surgery.

Purpose of the Study:

• To compare the effects of lignocaine with and without adrenaline, and saline with and without adrenaline, on hemodynamic parameters during craniotomy/craniectomy.
• To assess the impact of adrenaline on direct arterial pressure, heart rate, and bleeding at incision in patients undergoing cranial surgery.

Main Methods:

• Prospective, randomized, double-blind study involving 80 patients undergoing craniotomy or craniectomy.
• Comparison of scalp infiltration with four solutions: 0.5% lignocaine, 0.5% lignocaine with adrenaline 1:200,000, 0.9% saline, and 0.9% saline with adrenaline 1:200,000.
• Monitoring of direct arterial pressure, heart rate, and bleeding at incision.

Main Results:

• A significant decrease in arterial pressure (>20% from pre-infiltration values) occurred in 40% of patients receiving saline with adrenaline.
• Lignocaine with adrenaline resulted in a >20% decrease in arterial pressure in 55% of patients.
• No significant decrease in arterial pressure was observed in patients who did not receive adrenaline in their infiltration solution.

Conclusions:

• Adrenaline in scalp infiltration solutions is associated with a substantial risk of arterial hypotension in patients undergoing craniotomy or craniectomy.
• The findings suggest caution when using adrenaline-containing solutions for scalp infiltration in neurosurgery due to potential adverse hemodynamic effects.