Opioid sedation does not alter intracranial pressure in head injured patients

Lauer, Kathryn K.; Connolly, Lois A.; Schmeling, William T.

doi:10.1007/bf03011963

Cited by 42 publications

(32 citation statements)

References 17 publications

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“…Opioid receptor agonists, including the synthetic opioids fentanyl and alfentanil, are frequently used as anesthetic adjuncts during the perioperative management of neurosurgical patients. 10,11 Remifentanil is accepted as a reasonable alternative in neuroanesthesia. 11,12 Sedative-hypnotics and opioid analgesics are frequently used in combination to provide patient comfort, sedation, anxiolysis, and supplemental analgesia during outpatient surgical procedures performed under local anesthesia as part of a monitored anesthesia care technique.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Effects of Alfentanil, Fentanyl, and Remifentanil on Hemodynamic and Respiratory Parameters During Stereotactic Brain Biopsy

Bilgin

Moğol

Bekâr

et al. 2006

Journal of Neurosurgical Anesthesiology

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The aim of this study was to compare the effects of 3 different sedative-analgesic regimens in patients with intracranial mass lesions undergoing stereotactic brain biopsy. A 135 outpatients with American Society of Anesthesiologists I to II were divided into 3 groups: group A (n = 45) received a loading dose of IV alfentanil 7.5 microg/kg followed by infusion rate of 0.25 microg/kg/min; group F (n = 45) received a bolus dose of 1 microg/kg IV fentanyl and repeated as needed; and group R (n = 45) received infusion of 0.05 microg/kg/min remifentanil. Target level of sedation was 3 to 4 of the Ramsay Sedation Scale. Systolic and diastolic blood pressure, heart rate, respiratory rate, peripheric oxygen saturation (SpO2), and end-tidal carbon dioxide were recorded at different stages of the procedures. The patients in group F had significantly lower mean heart rate than those in groups A and R, but this was not in the limits of the bradycardia. The patients in group A had significantly lower mean SpO2 than those in the other groups, but mean SpO2 values did not drop below 94%. There were no significant differences in end-tidal carbon dioxide and respiratory rate values among the groups. Our results suggest that all 3 regimens have relatively similar hemodynamic and respiratory responses. The use of bolus fentanyl technique caused less hemodynamic stability. The continuous infusion technique of remifentanil or alfentanil provided better control on hemodynamic parameters.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Effects of Alfentanil, Fentanyl, and Remifentanil on Hemodynamic and Respiratory Parameters During Stereotactic Brain Biopsy

Bilgin

Moğol

Bekâr

et al. 2006

Journal of Neurosurgical Anesthesiology

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“…In adults with TBI, the reports have been contradictory. In four reports, three report an increase in ICP and the fourth reports a decrease in mean arterial pressure after administration of fentanyl or morphine [23][24][25][26]. It has been suggested that the observed increase in ICP may be related to cerebral autoregulatory reflexes that maintain CPP.…”

Section: Opioidsmentioning

confidence: 94%

Management of Pediatric Traumatic Brain Injury

Mtaweh

Bell

2015

Curr Treat Options Neurol

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Pediatric severe traumatic brain injury continues to be a major cause of disability and death. Rapid initial airway and hemodynamic stabilization is critical, followed by the need for immediate recognition of intracranial pathology that requires neurosurgical intervention. Intracranial hypertension and cerebral hypoperfusion have been recognized as major insults after trauma and management should be directed at preventing both. Sedation with opioids, moderate hyperventilation to arterial carbon dioxide level of 35-40 mmHg, hyperosmolar therapy with 3 % saline or mannitol, normothermia, and cerebrospinal fluid drainage continue to be the cornerstones of initial management of intracranial hypertension (intracranial pressure >20 mmHg). Refractory intracranial hypertension is treated with high-dose barbiturate therapy to achieve medical burst suppression on electroencephalography and decompressive craniectomy. In addition, those children require antiepileptic medications for seizure prophylaxis, adequate nutritional management, and early physical therapy and rehabilitation referrals. Most of the evidence for care of children with brain injury comes from center-specific practice and experience rather than objective data. This lack of evidence provides the ground for ongoing research; nevertheless, outcomes after traumatic brain injury continue to show improvement.

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“…Fentanyl and sulfentanyl must be used with caution because they have been associated with increases in ICP in patients with severe brain trauma, 12 although this may be avoidable with careful dose titration. 13 On the positive side, morphine sulfate is extremely effective in controlling symptoms of excessive autonomic arousal ("autonomic storms"). 14 Benzodiazepines are less expensive than propofol (especially lorazepam) and have the advantage of inducing amnesia, as well as sedation.…”

Section: Analgesia Sedation and Paralysismentioning

confidence: 99%