EFFECTS OF CISATRACURIUM ON CEREBRAL AND CARDIOVASCULAR HEMODYNAMICS IN PATIENTS WITH SEVERE BRAIN INJURY

Background: For neuroanesthesia and neurocritical care the use of drug s that do not increase or preferentially decrease intracranial pressur e (ICP) or change cerebral perfusion pressure (CPP) and cerebral blood now (CBF) are preferred. The current study investigates the effects o f a single rapid bolus dose of cisatracurium on cerebral blood flow ve locity, ICP, CPP, mean arterial pressure (MAP) and heart rate (HR) in 24 mechanically ventilated patients with intracranial hypertension aft er severe brain trauma (Glasgow coma scale <6) under continuous sedati on with sufentanil and midazolam. Methods: Patients were randomly assi gned to receive either 2xED95 (n=12) or 4xED95 (n=12) of cisatracurium as a rapid i.v. bolus injection. Before and after bolus administratio n mean cerebral blood flow velocity (BFV, cm/s) was measured in the mi ddle cerebral artery using a 2-MHz transcranial Doppler sonography sys tem, ICP (mm Hg) was measured using an extradural probe, and MAP (mm H g) and HR (b/min) were measured during a study period of 20 min. Cereb ral perfusion pressure (CPP=MAP-ICP) was also calculated. Results: Our data show that a single bolus dose of up to 4xED95 cisatracurium caus ed no significant (P<0.05) changes in BFV, ICP, CPP, MAP and HR. Possi ble histamine-related events were not observed during the study. Concl usions: The results from this study suggest that cisatracurium is a sa fe neuromuscular blocking agent for use in adult severe brain-injured patients with increased ICP under mild hyperventilation and continuous sedation.