The effect of propofol sedation on the intracranial pressure of patients with an intracranial space-occupying lesion.
The fear of producing CO(2) retention and a secondary increase of intracranial pressure (ICP) sometimes precludes the use of sedation for the spontaneously breathing patient in the presence of an intracranial space-occupying lesion. In this study we assessed the effect of moderately deep propofol sedation on the ICP of patients undergoing stereotactic brain tumor biopsy under regional anesthesia. Thirty patients were randomized into 2 groups to receive propofol titrated to a level of 2 on the Observer's Assessment of Alertness/Sedation Scale or no sedation. ICP was measured via the biopsy needle. Preoperative data were similar in both groups. During surgery, patients receiving propofol had a higher arterial Pco(2) (48 +/- 8 mm Hg versus 41 +/- 3 mm Hg; P = 0.005) (95% confidence interval, 43-53 mm Hg and 39-43 mm Hg, respectively), resulting in a lower arterial pH (P = 0.002) than patients in the no-sedation group. The median ICP (95% confidence interval) for both groups was similar-13 mm Hg (8.2-16.2 mm Hg) and 15 mm Hg (8.3-21.7 mm Hg)-for the propofol and no-sedation groups, respectively (P = 0.66). Cerebral perfusion pressure was lower in the propofol group (76 +/- 18 mm Hg versus 89 +/- 18 mm Hg; P = 0.003). Moderately deep propofol sedation does not result in a higher ICP than no sedation in patients undergoing stereotactic brain tumor biopsy. Further studies are needed to assess the effect on ICP of other sedative medications.
Girard
François
F
Department of Anesthesiology, Centre Hospitalier de l'Université de Montreal, Hôpital Notre-Dame, 1560 Sherbrooke East, Montreal, Quebec, Canada H2L 4M1. francois.girard.chum@ssss.gouv.qc.ca
Moumdjian
Robert
R
Boudreault
Daniel
D
Chouinard
Philippe
P
Bouthilier
Alain
A
Sauvageau
Eric
E
Ruel
Monique
M
Girard
Dominique C
DC
D000368:Aged; D001706:Biopsy; D001810:Blood Volume / Q000187:drug effects; D001932:Brain Neoplasms / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives; D007427:Intracranial Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015742:Propofol; D011446:Prospective Studies; D013238:Stereotaxic Techniques; D014661:Vasoconstriction / Q000187:drug effects
D006993:Hypnotics and Sedatives; D015742:Propofol