Changes in Intracranial Pressure Associated With Extradural Anaesthesia

Abstract

The intracranial pressure (ICP) response to the lumbar extradural injection of bupivacaine hydrochloride was measured in two patients on a total of 29 occasions. In the first patient, mean ICP increased from an average figure of 18.8 mm Hg to 39.5 mm Hg after the injection of 10 ml of solution. This increase was maintained for an average of 4.5 min. Both the magnitude and the duration of the increase were less when 5 ml was injected. The second patient had a normal baseline ICP, but the injection of bupivacaine 10 ml produced an increase from a mean of 9.3 mm Hg to 15.6 mm Hg. Injection of the same volumes of physiological saline in the second patient induced increases in ICP similar to those obtained with bupivacaine. There was a good correlation between baseline ICP and the increase produced by the extradural injection. It is concluded that extradural anaesthesia must be used with extreme caution in patients with reduced intracranial compliance, and should not be used at all in a patient with intracranial hypertension or a space-occupying lesion.

Extracranial Vertebral Aneurysm in Pregnancy: A Case Report on the Anesthetic Management during a Cesarean Section

“…However, there are reports of intracranial subdural hematoma formation after epidural anesthesia and subarachnoid hemorrhage after spinal anesthesia [11][12][13][14][15][16][17]. It is thought that they were the result of acute CSF pressure changes.…”

Epidural anesthesia for Cesarean delivery in a patient with post-traumatic cervical syringomyelia

“…There is still a possibility of sudden distension of the epidural space due to the local anesthetic injection, which in turn could induce subarachnoid space compression thereby increasing ICP and creating a potentially damaging pressure wave within the syrinx. 10,23,24 To minimize this problem, gradual titration of local anesthetic was instituted through an epidural catheter. Considering the patient's chronic pain syndrome, the added advantage of placing an epidural catheter was to provide additional local anesthetics and opioids if required in the postoperative period.…”

Management of idiopathic intracranial hypertension in parturients: anesthetic considerations

“…However, there have been concerns that 68 Similarly, Hilt et al have recorded a great increase in ICP in a patient with intracranial hypertension following lumbar extradural injection of bupivacaine 10 mL, even though the study was not specific for IIH. 69 Accordingly, cerebral blood flow is reduced markedly for a short time after injection. For this reason, vaginal delivery using an intrathecal catheter has also been suggested.…”