title: The effect of reversal of myoneural blockade on cerebrospinal fluid pressure following cerebral aneurysm surgery.
abstract: Drugs with a depolarizing action at the myoneural junction may cause a rise in intracranial pressure. Neostigmine, which is commonly used to reverse residual myoneural blockade, has a depolarizing action, and yet its effect on intracranial pressure is unknown. Lumbar cerebrospinal fluid pressure, which mirrors intracranial pressure, was determined in 12 patients undergoing cerebral aneurysm surgery. Cerebrospinal fluid pressure was measured during dense myoneural blockade and after its reversal with neostigmine. These effects on cerebrospinal fluid pressure were compared with those produced when the arterial partial pressure of carbon dioxide (PaCO2) rose from 4 to 5 kPa. After reversal of myoneural block, there was a small (non-significant) change in cerebrospinal fluid pressure from 3.6 to 4.3 kPa and a larger (significant) rise in cerebrospinal fluid pressure to 9.7 kPa when the PaCO2 was allowed to rise. In this group of patients, reversal of myoneural blockade with neostigmine causes no significant change in cerebrospinal fluid pressure.
authors.affiliation: Department of Anaesthesia, St. George's Hospital Medical School, London, UK.
authors.forename: W J
authors.initials: WJ
authors.lastname: Fawcett
authors.forename: R A
authors.initials: RA
authors.lastname: Chung
authors.forename: C J
authors.initials: CJ
authors.lastname: Fairley
authors.forename: T E
authors.initials: TE
authors.lastname: Hollway
mesh_terms: D000328:Adult; D000368:Aged; D016280:Atrial Function, Right; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D015170:Cerebrospinal Fluid Pressure / Q000187:drug effects*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage / Q000494:pharmacology*; D009469:Neuromuscular Junction / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors*; D010313:Partial Pressure; D011312:Pressure; D012123:Pulmonary Ventilation; D014673:Vecuronium Bromide / Q000037:antagonists & inhibitors*
chemical_list: D002800:Cholinesterase Inhibitors; D003473:Neuromuscular Nondepolarizing Agents; D002245:Carbon Dioxide; D009388:Neostigmine; D014673:Vecuronium Bromide