Effects of neck position and head elevation on intracranial pressure in anaesthetized neurosurgical patients: preliminary results

Details

Serval ID
serval:BIB_4891B8234AEC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Effects of neck position and head elevation on intracranial pressure in anaesthetized neurosurgical patients: preliminary results
Journal
Journal of Neurosurgical Anesthesiology
Author(s)
Mavrocordatos  P., Bissonnette  B., Ravussin  P.
ISSN
0898-4921
Publication state
Published
Issued date
01/2000
Peer-reviewed
Oui
Volume
12
Number
1
Pages
10-4
Notes
Clinical Trial
Journal Article
Randomized Controlled Trial --- Old month value: Jan
Abstract
This study reports the collective effect of the positions of the operating table, head, and neck on intracranial pressure (ICP) of 15 adult patients scheduled for elective intracerebral surgery. Patients were anesthetized with propofol, fentanyl, and maintained with a propofol infusion and fentanyl. Intracranial pressure was recorded following 20 minutes of stabilization after induction at different table positions (neutral, 30 degrees head up, 30 degrees head down) with the patient's neck either 1) straight in the axis of the body, 2) flexed, or 3) extended, and in the five following head positions: a) head straight, b) head angled at 45 degrees to the right, c) head angled at 45 degrees to the left, d) head rotated to the right, or e) head rotated the left. For ethical reasons, only patients with ICP < or = 20 mm Hg were included. Intracranial pressure increased every time the head was in a nonneutral position. The most important and statistically significant increases in ICP were recorded when the table was in a 30 degree Trendelenburg position with the head straight or rotated to the right or left, or every time the head was flexed and rotated to the right or left-whatever the position of the table was. These observations suggest that patients with known compromised cerebral compliance would benefit from monitoring ICP during positioning, if the use of a lumbar drainage is planed to improve venous return, cerebral blood volume, ICP, and overall operating conditions.
Keywords
Adult Aged Analysis of Variance *Anesthesia, Intravenous Anesthetics, Intravenous/administration & dosage Blood Pressure/physiology Blood Volume/physiology Brain/*surgery Central Venous Pressure/physiology Cerebrovascular Circulation/physiology Equipment and Supplies, Hospital Female Fentanyl/administration & dosage Head/*anatomy & histology Head-Down Tilt/physiology Heart Rate/physiology Humans Intracranial Pressure/*physiology Male Middle Aged Neck/*anatomy & histology Operating Rooms *Posture/physiology Propofol/administration & dosage Prospective Studies Spinal Puncture
Pubmed
Web of science
Create date
17/01/2008 16:20
Last modification date
20/08/2019 13:55
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