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Intracranial pressure and haemodynamic changes during the tunnelling phase of ventriculoperitoneal shunt insertion

Published online by Cambridge University Press:  25 November 2005

H. Prabhakar ,
G. P. Rath ,
P. K. Bithal  and
R. S. Chouhan
H. Prabhakar
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesiology, New Delhi, India
G. P. Rath
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesiology, New Delhi, India
P. K. Bithal
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesiology, New Delhi, India
R. S. Chouhan
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesiology, New Delhi, India
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Extract

Summary

Background and objective: The tunnelling phase of ventriculoperitoneal shunt insertion is the most painful part but patients are often given inadequate opioid analgesic for fear of post operative delayed recovery and/or respiratory depression. This may result in an increase in intracranial pressure. Methods: Twenty adults scheduled to undergo ventriculoperitoneal shunt insertion were administered standard anaesthesia. Monitoring included heart rate, electrocardiogram, end-tidal carbon dioxide, invasive blood pressure, and oxygen saturation. Intracranial pressure was monitored by placing the ventricular end of shunt catheter in the dilated lateral ventricle. Five minutes before tunnelling, fentanyl 1 μg kg−1 was administered. Mean arterial pressure, heart rate and intracranial pressure were recorded during tunnelling and subsequently at 1-min interval for 5 min. Data were analysed using t-test and repeated measured test. Results: Tunnelling caused significant increase in mean arterial pressure (from 81.4 ± 11.0 to 110.9 ± 15.3 mmHg, P < 0.05), intracranial pressure (from 21.4 ± 8.1 to 29.2 ± 12.5 mmHg, P < 0.05) and heart rate (from 74.4 ± 13.8 to 94.1 ± 17.8 beats min−1, P < 0.05). Whereas, the increase in haemodynamic parameters persisted for 3 min post-tunnelling, elevated intracranial pressure lasted for 2 min. Conclusion: Tunnelling significantly increases intracranial pressure and blood pressure despite prior fentanyl administration. This may be deleterious in the presence of intracranial pathology.

Keywords

VENTRICULOPERITONEAL SHUNTINTRACRANIAL PRESSUREPHYSIOLOGICAL MEASUREMENT TECHNIQUES, blood pressure, heart rateSURGICAL PROCEDURES, intracranialANAESTHESIA GENERALNARCOTICS, fentanyl
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 12 , December 2005 , pp. 947 - 950
Copyright
© 2005 European Society of Anaesthesiology

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References

Piatt Jr JH. Hydrocephalus treatment. In: Wilkins RH, Rengachary SS, eds. Neurosurgery. New York, USA: The McGraw-Hill Companies, 1996: 3633–3643.
Chambers N, Lopez T, Thomas J, James MFM. Remifentanil and the tunnelling phase of paediatric ventriculoperitoneal shunt insertion. A double blind, randomized, prospective study. Anaesthesia 2002; 57: 133–139.Google Scholar
Endo H, Larsen B, Lassen NA. Regional cerebral blood flow alterations remote from the site of intracranial tumors. J Neurosurg 1977; 46: 271–281.Google Scholar
Weaver DD, Winn HR, Jane JA. Differential intracranial pressure in patients with unilateral mass lesions. J Neurosurg 1982; 56: 660–665.Google Scholar
Bergsneider M, Becker DP. Intracranial pressure monitoring. In: Cottrell JE, Smith DS, eds. Anesthesia and Neurosurgery. Missouri, USA: Mosby Inc., 2001: 101–113.
Fitch W, Andrews P. Cerebral blood flow and its regulation-effects of anaesthesia. In: Prys-Roberts C, Brown Jr BR, eds. International Practice of Anaesthesia. Oxford, UK: Butterworth-Heinemann, 1996: 1/87/1–1/87/10.
From RP, Warner DS, Todd MM, Sokol MD. Anesthesia for craniotomy: a double-blind comparison of alfentanil, fentanyl and sufentanil. Anesthesiology 1990; 73: 896–904.Google Scholar
Todd MM, Warner DS, Sokoll MD et al. A prospective, comparative trial of three anesthetics for elective supratentorial craniotomy. Anesthesiology 1993; 78: 1005–1020.Google Scholar
Marx W, Shah N, Long C et al. Sufentanil, alfentanil and fentanyl: impact on cerebrospinal fluid pressure in patients with brain tumors. J Neurosurg Anesthesiol 1989; 1: 3–7.Google Scholar
Jamali S, Ravussin P, Archer D, Goutallier D, Parker F, Ecoffey C. The effects of bolus administration of opioids on cerebrospinal fluid pressure in patients with supratentorial lesions. Anesth Analg 1996; 82: 600–606.Google Scholar
Strebel S, Lam AM, Matta B, Mayberg TS, Aaslid R, Newell D. Dynamic and static cerebral autoregulation during isoflurane, desflurane and propofol anesthesia. Anesthesiology 1995; 83: 66–76.Google Scholar
Petersen KD, Landsfeldst U, Cold G et al. Intracranial pressure and cerebral hemodynamic in patients with cerebral tumors. Anesthesiology 2003; 98; 329–336.Google Scholar
Fraga M, Rama-Maceiras P, Rodino S, Aymerich H, Pose P, Belda J. The effects of isoflurane and desflurane on the intracranial pressure, cerebral perfusion pressure and cerebral arteriovenous oxygen content difference in normocapnic patients with supratentorial brain tumors. Anesthesiology 2003; 98: 1085–1090.Google Scholar
Glass PS, Hardman HD, Kamiyama Y, Donn KH, Hermann DJ. Pharmacodynamic comparison of GI87084B (GI), remifentanil, a novel, ultra-short acting opioid, and alfentanil. Anesth Analg 1992; 74: S113.Google Scholar
Monk TG, Batenhorst R, Jamerson B, Gupta S, Muir K, McNeal S. Comparison of remifentanil and alfentanil concentrations with stress hormone responses during nitrous-narcotic anesthesia. Anesthesiology 1995; 83: A380.Google Scholar
Baker KZ, Ostapokovich N, Jackson T, Ornstein E, Young WL. Cerebral blood flow reactivity is intact during remifentanil, nitrous oxide anesthesia. Anesth Analg 1995; 80: S27.Google Scholar
Forde S, Kumar N, Marcus R, Thompson J. Effect of remifentanil on cerebral blood flow, carbon dioxide reactivity and cerebral pressure autoregulation. Br J Anaesth 1999; 82: 454PGoogle Scholar
Warner DS, Hindman BJ, Todd MM et al. Intracranial pressure and hemodynamic effects of remifentanil vs. alfentanil in patients undergoing supratentorial craniotomy. Anesth Analg 1996; 83: 348–353.Google Scholar