EFFECT OF POSITIONING ON INTRACRANIAL-PRE SSURE

Citation
F. Porchet et al., EFFECT OF POSITIONING ON INTRACRANIAL-PRE SSURE, Annales francaises d'anesthesie et de reanimation, 17(2), 1998, pp. 149-156
Citations number
34
Categorie Soggetti
Anesthesiology
ISSN journal
07507658
Volume
17
Issue
2
Year of publication
1998
Pages
149 - 156
Database
ISI
SICI code
0750-7658(1998)17:2<149:EOPOIS>2.0.ZU;2-G
Abstract
The question as to whether the head and trunk of neurosurgery patients should be elevated remains controversial. This question is particular ly important when intracranial hypertension is present. Head up positi on may have beneficial effects on intracranial pressure (ICP) via chan ges in mean arterial pressure (MAP), airway pressure, central venous p ressure and cerebro spinal fluid displacement. However, in some circum stances, head up position may decrease MAP which in turn will result i n a paradoxical rise in ICP through autoregulation mechanisms. Therefo re, the degree of head elevation has to be titrated by evaluating the most adequate cerebral perfusion pressure (CPP) for each patient by me ans of transcranial Doppler or measurement of jugular venous blood oxy gen saturation. Head elevation above 30 degrees should be avoided in a ll cases. in most patients with intracranial hypertension, head and tr unk elevation up to 30 degrees is useful in helping to decrease ICP, p rovidest that a safe CPP of at least 70 mmHg or even 80 mmHg is mainta ined. Patients in poor haemodynamic conditions are best nursed flat. C PP is thus the most important factor in assessment and monitoring when considering head elevation in patients with increased ICP. (C) 1998 E lsevier, Paris.