title: The effect of sedation on intracranial pressure in patients with an intracranial space-occupying lesion: remifentanil versus propofol.
abstract: BACKGROUND
  In this study, we compared the effect of light sedation with remifentanil versus propofol on intracranial (ICP) and cerebral perfusion pressure (CPP) of patients undergoing stereotactic brain tumor biopsy under regional anesthesia.
  
  
  METHODS
  This was a prospective, open-label, randomized, and controlled study. Forty patients undergoing stereotactic brain tumor biopsy under regional anesthesia were randomized into two groups to receive remifentanil or propofol titrated to a level of four on the modified Assessment of Alertness/Sedation Scale. ICP was measured via the biopsy needle.
  
  
  RESULTS
  At the targeted level of sedation, the rates of infusion for remifentanil and propofol were, respectively, 4.2 +/- 1.8 microg x kg(-1) x h(-1) and 4.3 +/- 2.5 mg x kg(-1) x h(-1). At the time of ICP measurement, patients in the remifentanil group had a slower respiratory rate (11/min +/- 3 vs 15 per min +/- 3, P = 0.0001) and a higher PCO2 (48.3 +/- 6.2 mm Hg vs 43.1 +/- 5.5 mm Hg, P = 0.009) than patients in the propofol group. The mean was similar for both groups, 19.0 +/- 11.9 mm Hg vs 16.4 +/- 11.1 mm Hg for remifentanil and propofol, respectively (P = 0.48). Higher mean arterial blood pressure in the remifentanil group (101.1 +/- 13.7 mm Hg vs 85.8 +/- 12.7 mm Hg, P = 0.0008) resulted in a higher CPP than the propofol group: 82.0 +/- 19.0 mm Hg vs 69.5 +/- 17.0 +/- 19.0 mm Hg (P = 0.03).
  
  
  CONCLUSIONS
  Light sedation with remifentanil does not result in a higher ICP than propofol in patients undergoing stereotactic brain tumor biopsy. CPP might be better preserved with remifentanil.
authors.affiliation: Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, 1560 Sherbrooke East, Montreal, Canada, H2L 4M1. francois.girard.chum@ssss.gouv.qc.ca
authors.forename: Francois
authors.initials: F
authors.lastname: Girard
authors.forename: Robert
authors.initials: R
authors.lastname: Moumdjian
authors.forename: Daniel
authors.initials: D
authors.lastname: Boudreault
authors.forename: Philippe
authors.initials: P
authors.lastname: Chouinard
authors.forename: Alain
authors.initials: A
authors.lastname: Bouthilier
authors.forename: Monique
authors.initials: M
authors.lastname: Ruel
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D007427:Intracranial Pressure / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000494:pharmacology*; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D000077208:Remifentanil; D014851:Wakefulness / Q000187:drug effects / Q000502:physiology
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol