The effects of bolus administration of opioids on cerebrospinal fluid pressure in patients with supratentorial lesions

Details

Serval ID
serval:BIB_7DCBEDBC5F15
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The effects of bolus administration of opioids on cerebrospinal fluid pressure in patients with supratentorial lesions
Journal
Anesthesia and Analgesia
Author(s)
Jamali  S., Ravussin  P., Archer  D., Goutallier  D., Parker  F., Ecoffey  C.
ISSN
0003-2999
Publication state
Published
Issued date
03/1996
Peer-reviewed
Oui
Volume
82
Number
3
Pages
600-6
Notes
Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial --- Old month value: Mar
Abstract
In many studies reporting an increase in cerebrospinal fluid pressure (CSFP) after opioid administration, concomitant decreases in mean arterial pressure (MAP) have been observed. Autoregulatory cerebral vasodilation may therefore have been a factor in the CSFP increases. We tested the hypothesis that increases in CSFP after bolus injection of opioids could be minimized by modifying concomitant decreases in MAP with phenylephrine. Thirty-three patients with supratentorial mass lesions were studied in a randomized, prospective, double-blind, saline-controlled comparative trial. The principal outcome measures were lumbar CSFP, MAP, and heart rate (HR). Study drugs, sufentanil 0.8 micrograms/kg (n = 12), fentanyl 4.5 micrograms/kg (n = 11), or normal saline (n = 10), were injected intravenously (IV) during stable general anesthesia with 0.3-0.7 minimum alveolar anesthetic concentration (MAC) of isoflurane in oxygen and controlled ventilation (end-tidal carbon dioxide 32-35 mm Hg). Phenylephrine 50-100 micrograms was injected IV when MAP decreased by more than 15% of initial values, and atropine 0.5 mg IV when HR decreased to less than 45 bpm. Opioid administration was associated with significant decreases in MAP, 21 +/- 9 mm Hg (mean +/- SD) in the sufentanil group and 16 +/- 7 mm Hg in the fentanyl group; P < 0.001. These decreases in MAP were of short duration (i.e., corrected with 1-2 min). Patients in the sufentanil group needed more phenylephrine than patients in the fentanyl group (170 +/- 89 micrograms vs 100 +/- 47 micrograms; P < 0.05). No significant change in the CSFP was seen in either the sufentanil (1 +/- 6 mm Hg) or fentanyl-treated patients (O +/- 2 mm Hg). No significant changes in MAP or CSFP were observed in the saline-treated patients. HR decreased after injection of either study drug (P < 0.01) but remained unchanged in the saline group. In summary, during stable anesthesia with isoflurane in oxygen, bolus injections of fentanyl or sufentanil, despite producing rapidly corrected mean decreases in MAP of 18% and 25%, respectively, were not associated with any change in CSFP.
Keywords
Adult Aged Anesthetics, Inhalation/administration & dosage Anti-Arrhythmia Agents/administration & dosage Atropine/administration & dosage Blood Pressure/drug effects Bradycardia/prevention & control Cerebral Arteries/drug effects Cerebrospinal Fluid Pressure/*drug effects Double-Blind Method Fentanyl/*pharmacology Heart Rate/drug effects Homeostasis/drug effects Humans Hypotension/prevention & control Injections, Intravenous Isoflurane/administration & dosage Middle Aged Phenylephrine/administration & dosage Placebos Prospective Studies Respiration, Artificial Sufentanil/*pharmacology Supratentorial Neoplasms/*surgery Treatment Outcome Vasoconstrictor Agents/administration & dosage Vasodilation
Pubmed
Web of science
Create date
17/01/2008 16:20
Last modification date
20/08/2019 14:39
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