Effects of Sufentanil on Cerebral Hemodynamics and Intracranial Pressure in Patients with Brain Injury

Abstract

The current data show that sufentanil (3 micrograms/kg intravenous) has no significant effect on middle cerebral artery blood flow velocity and ICP in patients with brain injury, intracranial hypertension, and controlled MAP. However, transient increases in ICP without changes in middle cerebral artery blood flow velocity may occur concomitant with decreases in MAP. This suggests that increases in ICP seen with sufentanil may be due to autoregulatory decreases in cerebral vascular resistance secondary to systemic hypotension.

Effect of remifentanil on intracranial pressure and cerebral blood flow velocity in patients with head trauma

“…However, increases in ICP along with infusion of opioids were always associated with decreases in MAP, suggesting that a rise in ICP was related to autoregulatory vasodilation and increased cerebral blood volume secondary to systemic hypotension. This is supported by an investigation in patients with brain injury and sufentanil infusion, where ICP periodically increased concomitant with a decrease in MAP of >10 mmHg but was unchanged in patients with MAP-control (7). In that study CBFV (as an index of flow) in the middle cerebral artery remained constant after sufentanil administration, which further supports the autoregulatory hypothesis (7).…”

Effects of sufentanil or ketamine administered in target-controlled infusion on the cerebral hemodynamics of severely brain-injured patients*

“…As opposed to bolus, a continuous infusion of sufentanil did not alter MAP and ICP (1). Werner et al (19) emphasized the role of MAP, showing that a bolus of sufentanil did not change ICP when MAP was maintained constant by the use of a norepinephrine infusion.…”

Intensive Care Management of the Traumatic Brain Injury

“…However, the cerebrovascular effects of such drugs remain controversial. Studies in laboratory animals and humans have shown increases, decreases or no change in ICP after opioid administration (109)(110)(111)(112)(113)(114)(115)(116)(117)(118)(119)(120) . Most of these studies find a concomitant decrease in systemic arterial pressure and, recently, it has been suggested that reduced MAP could in fact be responsible for the increases in ICP observed after the administration of potent opioids such as sufentanil (107) .…”