Propofol Sedation in Severe Head Injury Fails to Control High ICP, but Reduces Brain Metabolism

Traumatic Brain Injury - Acute Care

“…Continuous electroencephalography allows the clinician to titrate to burst-suppression, thereby ensuring that the minimum effective dose is employed. Several other agents, including propofol and midazolam, can be used to suppress CNS metabolism and induce burst-suppression, though they do not appear to be as effective as barbiturates in the treatment of intracranial hypertension Stewart et al 1994). Unfortunately, no comparative trials are available.…”

Propofol: Effects on the Central Nervous System

“…Stewart et al [33] compared propofol with midazolam/morphine sedation in 15 adults with TBI. Propofol was administered as a continuous infusion (150–400 mg/hr).…”

“…They also suggested that the decrease in CMRO 2 resulted in an increase in CVR, although no direct measurements were made. These investigators also reported in adults with TBI that propofol by continuous infusion did not reduce ICP and the effect on AVDO 2 was short‐lived (see above) [33].…”

“…Several studies demonstrated a decrease in ICP [27–32,34,37]; the effect being more pronounced in patients with TBI and elevated ICP. Conflicting data with no effect on ICP has also been reported [33]. The overall effect on CPP varies depending on the effect of propofol on MAP.…”

“…The data available concerning the effects of propofol on SjO 2 , AVDO 2 , and CVR remain somewhat conflicting. Some investigators have demonstrated an increased SjO 2 and decreased AVDO 2 [33,36], others have demonstrated no effect of propofol on these parameters [35], while others show a decreased SjO 2 and increased AVDO 2 [39]. Another group showed no effect of propofol on decreases in SjO 2 which occurred following CPB [39].…”