BJA Advance Access published online on February 2, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aen381
Influence of an increased intracranial pressure on cerebral and systemic haemodynamics during endoscopic neurosurgery: an animal model
1 Department of Anaesthesia and Critical Care Medicine, O.L.V. Clinic, 9300 Aalst, Belgium
2 Department of Physiology and Pathophysiology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
3 Department of Pathology, N. Goormaghtigh Institute
4 Department of Anaesthesia, Ghent University, Ghent, Belgium
5 Department of Anaesthesia, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
* Corresponding author. E-mail: AlainKalmar{at}gmail.com
Background: During endoscopic neurosurgery, direct mechanical stimulation of the brain by the endoscope and increased intracranial pressure (ICP) caused by the continuous rinsing can induce potentially lethal haemodynamic reflexes, brain ischaemia, and excessive fluid resorption.
Methods: In a newly presented rat model of endoscopic neurosurgery, stereotactic access to the cerebrospinal fluid was secured and the ICP was increased by controlled infusion until complete suppression of the cerebral perfusion pressure (CPP). The haematocrit (Hct) level was determined before and after the procedure. During the whole procedure, invasive arterial pressure, ICP, and heart rate were continuously recorded and evaluated in a subsequent offline analysis. After the procedure, the animals were allowed to recover and 7 days later they were killed for histological examination.
Results: Suppression of the CPP resulted in a severe hypertension combined with tachycardia or mild bradycardia. The Hct decreased from 41 to 35 over the minutes of CPP suppression. After cessation of the infusion, the ICP decreased to 37% of the plateau pressure within 2.5 s. In the first few minutes after restoration of normal ICP, five animals died because of pulmonary oedema.
Conclusions: Upon complete suppression of the CPP, an obvious hypertension developed, often together with tachycardia, but no severe bradycardia. At high ICP levels, we observed an important translocation of irrigation fluid to the vascular space. Fatality was not caused by ischaemia or arrhythmia but due to pulmonary oedema.
Keywords: anaesthesia, neurosurgical; brain, blood flow; brain, intracranial pressure; brain, ischaemia; cardiovascular system, responses; cerebrospinal fluid; complications, cerebral ischaemia; complications, pulmonary oedema, neurogenic; fluids, irrigating; lung, oedema; measurement techniques, blood flow; monitoring, intracranial pressure; surgery, endoscopy; surgery, neurological