Effects of Induction on Changes of Intracranial Pressure and Vital Signs during General Anesthesia / 대한마취과학회지

ABSTRACT

It is true that intracranial pressure(ICP) and mean arterial pressure(MAP) are increased by induction of conventional inhalation general anesthesia, and it may be very dangerous in neurosurgical patients who had increased ICP. Therefore, this study was performed to know the ranges of ICP and MAP increase during induction of the general anesthesia with laryngoscopy and endotracheal intubation following thiopental sodium(4mg/kg) and succinyeholine chioride(1 mg/kg) injections in 16 neurosurgical patients with normal pulmonary and cardiac functions. All the patients were monitored ICP and intraarterial pressure preoperatively, and intracranial compliance, ICP, MAP and pulse rate were measured in all patients during induction of general anesthesia. The results were as follows: 1) Intracranial compliance; ICP during endotracheal intubation increased by 2 mmHg in those patients with pre-operatively normal range of compliance, but in those patients with compliance range of 2-3 ml/CmH2O, mean ICP increase was 5. 6+/-2. 45 mmHg, and in those patients with compliance range of 4-6 ml/CmH2O, it was 13. 010. 23 mmHg. 2) Mean ICP increased from 13.5+/-6.16 mmHg at pre-induction to-20.4+/-10.02 mmHg during endotracheal intubation, but it was not statistically significant(p>0.05) because the rate of ICP increase was not remarkable by endotracheal intubation in the patients without ICP increase in pre-induction. 3) Mean arterial pressure increased significantly from 116.71+/-6.65 mmHg at pre-induction to 160. 3+/-34. 24 mmHg during endotracheal intubation(P<0.05). 4) Pulsse rate increased significantly from 94.8+/-20.28 beat/min to 120.5+/-15.93 beat/min(p<0.001). 5) Cerebral perfusion pressure increased from 103.3+/-14.49mmHg 137.3+/- 35.91mmHg(p<0.025). It is stressed that certain procedures are necessary to prevent from further increase of ICP due to induction of general anesthesia in patient with increased ICP.