The intravenous administration of Althesin 50 /d/kg to 9 patients undergoing neurosurgery during general anaesthesia with controlled ventilation resulted in a fall in intracranial pressure (i.c.p.) measured in one lateral ventricle. The extent of the reduction in intracranial pressure was directly proportional to the starting value of pressure. Intracranial pressure gradually returned to control values over 10 min. Blood pressure also fell significantly but the extent of its reduction was not sufficient in itself to account for the change in intracranial pressure. It is postulated that the intracranial pressure fall was the result of a reduction in cerebral blood flow and cerebral blood volume. Althesin would therefore appear to be a satisfactory drug for use in patients with intracranial compression.
SUMMARY Disadvantages associated with the use of ventricular catheters for the prolonged measurement of intracranial pressure have resulted in the search for an alternative technique. Measurement of pressure from the extradural space is one such possibility, but widespread acceptance of this procedure has been limited by the technical difficulties associated with this measurement and lack of information on the relationship between cerebrospinal fluid and extradural pressures. A study to investigate this relationship and to develop a simple and effective technique for measuring extradural pressure is described.In certain patients with head injuries and intracranial space-occupying lesions, acute rises in intracranial pressure producing brain shift or impairment of the cerebral circulation-with subsequent secondary brain damage-may occur before changes in vital signs are recognized. Furthermore, the reduction of intracranial pressure by means of one of the several methods currently available is too often unpredictable. For these reasons patient management may be greatly assisted, and more readily programmed, if intracranial pressure is directly monitored (Lundberg, Troupp, and Lorin, 1965;Johnston, Johnston, and Jennett, 1970 The aims of this study were: (1) to explore the relationship between extradural pressure, supratentorial subarachnoid pressure and ventricular pressure; (2) to assess the use of latex balloons as pressure-sensing devices in the extradural and subarachnoid spaces; (3) to evaluate a metal capsule, to be described, for clinical use in measuring extradural pressure over prolonged periods with minimal discomfort to the patient.
METHODSANIMAL STUDIES The experiments were carried out on 12 dogs, but two baboons were also studied because the dura mater in these primates is more like that in man, being only loosely attached to the skull. The dogs were intubated after induction with thiopentone sodium, and anaesthesia maintained with nitrous oxide, oxygen, and halothane. Artificial ventilation to normocarbia and normoxia was achieved with the aid of muscle relaxants. Body temperature was maintained at 370 C. The baboons were premedicated with phencyclidine 0 5-1 mg/kg 514
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