The effects of indomethacin on intracranial pressure, cerebral blood flow and cerebral metabolism in patients with severe head injury and intracranial hypertension.
In five head-injured patients with cerebral contusion and oedema in whom it was not possible to control intracranial pressure (ICP) (ICP greater than 20 mmHg) by artificial hyperventilation (PaCO2 level 3.5-4.0 kPa) and barbiturate sedation, indomethacin was used as a vasoconstrictor drug. In all patients, indomethacin (a bolus injection of 30 mg, followed by 30 mg/h for seven hours) reduced ICP below 20 mmHg for several hours. Studies of cerebral circulation and metabolism during indomethacin treatment showed a decrease in CBF at 2 h. After 7 h, ICP remained below 20 mmHg in three patients, and these still had reduced CBF. In the other patients a return of ICP and CBF to pretreatment levels was observed. In all patients indomethacin treatment was followed by a fall in rectal temperature. These results suggest that indomethacin due to its cerebral vasoconstrictor and antipyretic effect should be considered as an alternative for treatment of ICP-hypertension in head-injured patients.
Jensen
K
K
Department of Neuroanaesthesia, Arhus Kommunehospital, Denmark.
Ohrström
J
J
Cold
G E
GE
Astrup
J
J
D000328:Adult; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects; D001831:Body Temperature / Q000187:drug effects / Q000502:physiology; D001921:Brain / Q000098:blood supply; D001930:Brain Injuries / Q000188:drug therapy* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects* / Q000502:physiology; D004734:Energy Metabolism / Q000187:drug effects* / Q000502:physiology; D015600:Glasgow Coma Scale; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007427:Intracranial Pressure / Q000187:drug effects* / Q000502:physiology; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008297:Male; D010100:Oxygen / Q000097:blood; D011559:Pseudotumor Cerebri / Q000188:drug therapy* / Q000503:physiopathology
D007773:Lactates; D019344:Lactic Acid; D010100:Oxygen; D007213:Indomethacin