Intracranial pressure during induction of anaesthesia and tracheal intubation with etomidate-induced EEG burst suppression

Paul A. Modica, Rene Tempelhoff

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76 Scopus citations

Abstract

This study was designed to determine if induction of anaesthesia with etomidate titrated to an early EEG burst suppression pattern would produce minimal changes in cerebral perfusion pressure, and prevent increases in intracranial pressure (ICP) associated with tracheal intubation. Eight patients, 18-71 yr, with intracranial space-occupying lesions, were studied. In each patient ICP was monitored via a lateral ventriculostomy catheter placed preoperatively. In the operating room, an ECG, a radial arterial line, and a two-channel computerized EEG were placed. Control (awake) measurements of MAP (mmHg), ICP (mmHg), CPP(mmHg), heart rate (HR-bpm), EEG power(picowatts-pW), and spectral edge frequency (SEF, Hz) were obtained. Anaesthesia was induced with etomidate, 0.2 mg · kg-1 iv, followed immediately by an etomidate infusion, 20 mg · min-1, iv, and vecuronium 0.2 mg · kg-1 iv. When early burst suppression was achieved, the etomidate infusion was stopped and tracheal intubation performed. The etomidate dose (bolus plus infusion) required to reach burst suppression was 1.28 ± 0.11 mg · kg-1. Compared with awake control values (mean ± SE), the period from induction to burst suppression was associated with a 50% decrease in ICP (22 ± 1 vs 11 ± 1 mmHg, P < 0.01), but there were no changes in MAP, CPP, or HR. The decrease in ICP was maintained during the first 30 sec and the following 60 sec after intubation as MAP and HR remained unchanged. Our results suggest that when etomidate was administered to early burst suppression pattern on EEG, minimal changes in CPP occurred during induction of anaesthesia and a marked reduction in ICP was maintained following tracheal intubation.

Original languageEnglish
Pages (from-to)236-241
Number of pages6
JournalCanadian Journal of Anaesthesia
Volume39
Issue number3
DOIs
StatePublished - Mar 1 1992

Keywords

  • Anaesthetics, Intravenous: etomidate
  • Intubation: endotracheal
  • Measurement Techniques: blood pressure, electroencephalography, intracranial pressure, cerebral perfusion pressure

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