Head elevation reduces head-rotation associated increased ICP in patients with intracranial tumours

Abstract

Purpose: To quantify the effects of graded head rotation and elevation on intracranial pressure (ICP) in neurosurgical patients, before and after induction of general anesthesia.Methods: Patients with supratentorial tumours (n=12), scheduled for craniotomy with planned ICP monitoring, underwent baseline ICP measurements awake and supine (0° rotation and elevation). Incremental degrees of head rotation (15°) and of head elevation (10°) were performed independently and in combination. Paired measurements of ICP at all levels of head rotation and elevation were also performed before and after induction of general anesthesia (n=6).Results: The baseline ICP was 12.3 ± 6.4 mmHg (n=12). Changes of ICP were proportional to the degree of head rotation or elevation. Head rotation of 60° maximally increased ICP to 24.8 ± 14.3 mmHg (P < 0.05). Head elevation above 20° reduced ICP, with a maximal reduction to -0.2 ± 5.5 mmHg at 40° elevation (P < 0.01). Head elevation to 30° reduced the intracranial hypertension associated with head rotation. No differences were observed between ICP measurements made before or after induction of general anesthesia (n=6). Three patients experienced headache with extreme head rotation (<60°) and intracranial hypertension (ICP > 20 mmHg).Conclusion: Head rotation of 60° caused an increase in ICP. Concomitant head elevation to 30° reduced the intracranial hypertension associated with head rotation. Headache with head rotation may provide a useful clinical warning of elevated ICP.Objectif : Quantifier les effets de la rotation et de l'élévation graduées de la tête sur la tension intracrânienne (TIC) chez des patients de neurochirurgie, avant et après l'induction de l'anesthésie générale. Résultats : La TIC de base était de 12,3 ± 6,4 mmHg (n=12). Les changements de TIC ont été proportionnels au degré de rotation et d'élévation de la tête. La rotation de 60 o a conduit à la TIC maximale de 24,8 ± 14,3 mmHg (P < 0,05). L'élévation au-dessus de 20 o a réduit la TIC, la réduction maximale étant de -0,2 ± 5,5 mmHg à 40 o d'élévation (P < 0,01). L'élévation de la tête à 30 o a réduit l'hypertension intracrânienne associée à la rotation de la tête. Aucune différence de TIC n'a été notée entre les mesures prises avant ou après l'induction de l'anesthésie générale (n=6). Trois patients ont éprouvé des céphalées au moment de la rotation extrême de la tête (<60 o ) et une hypertension intracrânienne (TIC) > 20 mmHg.Conclusion : La rotation de la tête de 60 o a causé une augmentation de la TIC. L'élévation concomitante de la tête à 30 o a réduit la TIC associée à la rotation de la tête. Les céphalées associées à la rotation de la tête peuvent servir d'indice clinique d'une TIC élevée.

Effects of head rotation on the right internal jugular vein in infants and young children

“…We found that carotid artery overlap was greater in the 80° head rotated position and this degree of head rotation with neck extension during IJV cannulation can also increase the risk of airway leakage and tracheal extubation by displacing the tracheal tube’s tip towards the vocal cords during mechanical ventilation [14, 15]. Moreover, the increase in intracranial pressure is proportional to the degree of head rotation in patients who have elevated intracranial pressure [16]. Therefore, we suggest that the 40° head rotation position is superior to the 80° head rotation position.…”

Effect of head and body positioning on cerebral blood flow velocity in patients who underwent cranial surgery

“…It is previously shown that rotation, flexion and extension movements to the head affect the CBF and increase the ICP (Hung et al. 2000, Mavrocordatos et al.…”

“…It is previously shown that rotation, flexion and extension movements to the head affect the CBF and increase the ICP (Hung et al 2000, Mavrocordatos et al 2000. Our study showed that flexion and extension movements to the head in left and RLPs decrease the mCBF velocity, but this difference was not statistically significant (Table 3).…”

Ischemic Stroke and ICU Care

“…This can be seen when there is significantly decreased compliance due to high ICP and when the patient's head is allowed to flex laterally, leading to the compression of the draining vein. [27][28][29][30][31][32] The ventilation settings are best managed with the pulmonary needs of the patient in mind. Care should be taken to avoid, if possible, ventilatory settings that can worsen increased ICP.…”