Effect of Bolus Doses of Midazolam on Intracranial Pressure and Cerebral Perfusion Pressure in Patients With Severe Head Injury

Papazian, Laurent; Albanèse, Jacques; Thirion, Xavier; Perrin, G; Durbec, O.; Martin, Claude

doi:10.1093/bja/71.2.267

Cited by 61 publications

(28 citation statements)

References 20 publications

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“…2 As the administration of opioids may be associated with a circulatory depression and reduction of the CPP, 9,25,26 the supportive administration of catecholamines is not uncommon. Side effects of pressor agents like intestinal vasoconstriction, pharmacologic interaction with other medication, or vegetative symptoms are dreaded in intensive care medicine.…”

Section: Discussionmentioning

confidence: 99%

Effects of Fentanyl and S(+)-ketamine on Cerebral Hemodynamics, Gastrointestinal Motility, and Need of Vasopressors in Patients With Intracranial Pathologies

Schmittner¹,

Vajkoczy²,

Horn

et al. 2007

Journal of Neurosurgical Anesthesiology

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In neurosurgical patients, opioids are administered to prevent secondary cerebral damage. Complications often related to the administration of opioids are a decrease in blood pressure affording the use of vasopressors and intestinal atonia. One alternative approach to opioids is the application of S(+)-ketamine. However, owing to a suspected elevation of intracranial pressure (ICP), the administration of S(+)-ketamine has questioned for a long time. The aim of the present study was to evaluate ICP, gastrointestinal motility, and catecholamine consumption in neurosurgical patients undergoing 2 different protocols of anesthesia using fentanyl or S(+)-ketamine. Twenty-four patients sustaining traumatic brain injury or aneurysmal subarachnoid hemorrhage received methohexitone plus either fentanyl or S(+)-ketamine to establish a comparable level of sedation. To reach an adequate cerebral perfusion pressure (CPP), the norepinephrine dosage was adapted successively. Enteral nutrition and gastrointestinal stimulation were started directly after admission on the critical care unit. ICP, CPP, and norepinephrine dosage were recorded over 5 days and also the time intervals to full enteral nutrition and first defecation. There was no difference regarding ICP, CPP, and the time period until full enteral nutrition or first defecation between both groups. Patients who underwent analgesia with S(+)-ketamine showed a trend to a lower demand of norepinephrine compared with the fentanyl group. Our results indicate that S(+)-ketamine does not increase ICP and that its use in neurosurgical patients should not be discouraged on the basis of ICP-related concerns.

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Section: Discussionmentioning

confidence: 99%

Effects of Fentanyl and S(+)-ketamine on Cerebral Hemodynamics, Gastrointestinal Motility, and Need of Vasopressors in Patients With Intracranial Pathologies

Schmittner¹,

Vajkoczy²,

Horn

et al. 2007

Journal of Neurosurgical Anesthesiology

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“…Benzodiazepines, in general, reduce cerebral metabolic rate of oxygen, ICP, and cerebral blood flow and increase seizure threshold. However, adverse effects of benzodiazepines on cardiac performance (thereby affecting mean arterial pressure (MAP) and CPP) have been observed [28]. While studies in children are lacking, those from adult TBI victims found that midazolam and propofol were equally efficacious in ICP control with no noted adverse event [29][30][31].…”

Section: Main Drug Interactions Central Nervous System Depressantsmentioning

confidence: 99%

Management of Pediatric Traumatic Brain Injury

Mtaweh

Bell

2015

Curr Treat Options Neurol

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Pediatric severe traumatic brain injury continues to be a major cause of disability and death. Rapid initial airway and hemodynamic stabilization is critical, followed by the need for immediate recognition of intracranial pathology that requires neurosurgical intervention. Intracranial hypertension and cerebral hypoperfusion have been recognized as major insults after trauma and management should be directed at preventing both. Sedation with opioids, moderate hyperventilation to arterial carbon dioxide level of 35-40 mmHg, hyperosmolar therapy with 3 % saline or mannitol, normothermia, and cerebrospinal fluid drainage continue to be the cornerstones of initial management of intracranial hypertension (intracranial pressure >20 mmHg). Refractory intracranial hypertension is treated with high-dose barbiturate therapy to achieve medical burst suppression on electroencephalography and decompressive craniectomy. In addition, those children require antiepileptic medications for seizure prophylaxis, adequate nutritional management, and early physical therapy and rehabilitation referrals. Most of the evidence for care of children with brain injury comes from center-specific practice and experience rather than objective data. This lack of evidence provides the ground for ongoing research; nevertheless, outcomes after traumatic brain injury continue to show improvement.

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“…Midazolam (0.1-0.2 mg/kg IV) has a relatively rapid onset of action (3-5 min) and shorter duration [119] and should be used with caution in children with hemodynamic instability [121][122][123][124]. The hemodynamic effects may be more pronounced in newborns and infants [121,123], so particular caution should be exercised in this patient population.…”

Section: Induction Agentsmentioning

confidence: 99%

Assessment and Management of the Pediatric Airway

Wheeler

Spaeth

Mehta

et al. 2008

Resuscitation and Stabilization of the Critically Ill Child

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Anatomic features that differ between children and adults include (1) a proportionally larger head and occiput (relative to body size), causing neck fl exion and leading to potential airway obstruction when lying supine; (2) a relatively larger tongue, decreasing the size of the oral cavity; (3) decreased muscle tone, resulting in passive obstruction of the airway by the tongue; (4) a shorter, narrower, horizontally positioned, softer epiglottis; (5) cephalad and anterior position of the larynx; (6) shorter, smaller, narrower trachea; and (7) funnel-shaped versus cylindrical airway, such that the narrowest portion of the airway is located at the level of the cricoid cartilage (Figure 4.1).The fi rst and perhaps most obvious difference is that the pediatric airway is much smaller in diameter and shorter in length than the adult's. For example, the length of the trachea changes from approximately 4 cm in neonates to approximately 12 cm in adults, and the tracheal diameter varies from approximately 3 mm in the premature infant to approximately 25 mm in the adult [11,13]. According to Hagen-Poiseuille's law, the change in air fl ow resulting from a reduction in airway diameter is directly proportional to the airway radius elevated to the fourth power:

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Effect of Bolus Doses of Midazolam on Intracranial Pressure and Cerebral Perfusion Pressure in Patients With Severe Head Injury

Cited by 61 publications

References 20 publications

Effects of Fentanyl and S(+)-ketamine on Cerebral Hemodynamics, Gastrointestinal Motility, and Need of Vasopressors in Patients With Intracranial Pathologies

Effects of Fentanyl and S(+)-ketamine on Cerebral Hemodynamics, Gastrointestinal Motility, and Need of Vasopressors in Patients With Intracranial Pathologies

Management of Pediatric Traumatic Brain Injury

Assessment and Management of the Pediatric Airway

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