SUFENTANIL INCREASES INTRACRANIAL-PRESSURE IN PATIENTS WITH HEAD TRAUMA

Background. Sufentanil is an intravenous opioid often used as a compon ent of anesthesia during neurosurgical procedures. However, the effect s of sufentanil on intracranial pressure in patients with diminished i ntracranial compliance are not well established, and remain controvers ial. Methods: Ten patients with head trauma, in each of whom the trach ea was intubated, were studied for the effects of sufentanil on intrac ranial pressure (ICP) and on cerebral perfusion pressure (CPP). In all patients, ICP monitoring was instituted before the study. Sedation wa s obtained using a propofol infusion, and paralysis was achieved with vecuronium. After obtaining control of ICP (between 15 and 25 mmHg) he modynamic values and blood gas tensions (Pa(CO2) between 30 and 35 mmH g), the level of sedation was deepened with an intravenous injection o f sufentanil (1 mug/kg over 6 min), followed by an infusion of 0.005 m ug . kg-1 min-1. Mean arterial pressure (MAP), ICP (fiberoptic intracr anial pressure monitor), and end-tidal CO2 were continuously measured and recorded at 1-min intervals throughout the 30-min study period. Re sults: Sufentanil injection was associated with a statistically signif icant increase in ICP of 9 +/- 7 mmHg (+ 53%), which peaked at 5 min. Then ICP gradually decreased and returned to baseline after 15 min. Th is was accompanied by a significant decrease in MAP (24% decrease) and , thus, CPP (38% decrease). After 5 min, MAP and CPP gradually increas ed, but remained significantly decreased throughout the study. Conclus ions: The results of the current study indicate that caution should be exercised in the administration of sufentanil bolus to patients with abnormal intracranial elastance, particularly if ICP is significantly increased.