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BJA Advance Access published online on March 17, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael063
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted February 8, 2006

Case Report

Severe bradycardia and hypotension after connecting negative pressure to the subgaleal drain during craniotomy closure

K. Karamchandani 1, R. S. Chouhan 1 *, P. K. Bithal 1, and H. H. Dash 1

1 Department of Neuroanaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India

* To whom correspondence should be addressed.
R. S. Chouhan, E-mail: chouhanrs{at}hotmail.com


  Abstract

Negative pressure drainage systems are often used after craniotomy for evacuation of potential bleeding. There are several reports of haemodynamic disturbances with epidural negative pressure drainage, but such reports are very few for subgaleal drains placed over the bone flap. We report a case in which a patient developed severe cardiovascular disturbances after the vacuum drainage was connected to a subgaleal drain after craniotomy for aneurysm clipping. The patient had no significant cardiac history, had an uneventful intra-operative course and yet developed bradycardia and hypotension, which were reproducible and severe enough to require atropine administration. Anaesthetists must be aware of these effects, so that they can anticipate and treat such complications.

Keywords: complications, haemodynamic disturbances; drainage systems, negative pressure; drains, subgaleal; surgery, craniotomy.
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