title: The effect of skull-pin insertion on cerebrospinal fluid pressure and cerebral perfusion pressure: influence of sufentanil and fentanyl.
abstract: This randomized prospective study measured the effects of an intravenous opioid bolus on cerebrospinal fluid pressure (CSFP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) during skull-pin insertion. Twenty-two adult patients scheduled for elective craniotomy for supratentorial lesions were studied. Outcome variables were MAP, heart rate (HR), and lumbar CSFP. The standardized anesthetic regimen included fentanyl (2 microg/kg), thiopental (5-7 mg/kg), lidocaine (1.5 mg/kg), isoflurane (0.3-0.7 minimum alveolar anesthetic concentration), and vecuronium (0.1 mg/kg). During stable anesthesia, sufentanil (0.8 microg/kg) or fentanyl (4.5 microg/kg) was given as a bolus before skull-pin insertion. The hemodynamic effects of the opioid injection were modified with phenylephrine and/or atropine when indicated. CSFP remained unchanged in both treatment groups. MAP and CPP increased approximately 10 mm Hg after skull-pin insertion (P<0.001). In the sufentanil group, HR decreased approximately 10 bpm after opioid injection and remained decreased throughout the study. In fentanyl-treated patients, HR decreased 8 bpm after opioid injection but returned to preopioid rates after skull-pin insertion. In conclusion, in anesthetized patients, an intravenous bolus of fentanyl or sufentanil prior to skull-pin insertion results in stable values of CSFP, CPP, BP, and HR when the hemodynamic effects of the opioid are modified with phenylephrine and atropine.
authors.affiliation: Department of Anesthesiology, University of Paris-Sud, Le Kremlin Bicêtre, France.
authors.forename: S
authors.initials: S
authors.lastname: Jamali
authors.forename: D
authors.initials: D
authors.lastname: Archer
authors.forename: P
authors.initials: P
authors.lastname: Ravussin
authors.forename: M
authors.initials: M
authors.lastname: Bonnafous
authors.forename: P
authors.initials: P
authors.lastname: David
authors.forename: C
authors.initials: C
authors.lastname: Ecoffey
mesh_terms: D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology*; D001285:Atropine / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D001858:Bone Nails; D015170:Cerebrospinal Fluid Pressure / Q000187:drug effects*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D003399:Craniotomy / Q000379:methods; D004311:Double-Blind Method; D005283:Fentanyl / Q000494:pharmacology*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D007427:Intracranial Pressure / Q000187:drug effects*; D010477:Perfusion; D010656:Phenylephrine / Q000627:therapeutic use; D011446:Prospective Studies; D012886:Skull / Q000601:surgery*; D017409:Sufentanil / Q000494:pharmacology*
chemical_list: D000759:Adjuvants, Anesthesia; D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D010656:Phenylephrine; D001285:Atropine; D017409:Sufentanil; D005283:Fentanyl