Rapid intraoperative reduction of intracranial pressure with thiopentone

Abstract

Thiopentone was administered in bolus doses (1.5-3.0 mg/kg) 26 times to 18 neurosurgical patients undergoing craniotomy. Intracranial pressure and blood pressure responses to thiopentone were evaluated and the cerebral perfusion pressure calculated. Thiopentone given 21 times to treat chronic or acutely elevated intracranial pressure significantly reduced the mean pressure from 40 ± 1.5 to 22 ± 1.4 mm Hg (± SD). During these 21 treatments the cerebral perfusion pressure increased in 15, remained stable in 2 and decreased in 3. With induction of anaesthesia in patients with normal pre-thiopentone pressures, the barbiturate produced no significant alteration in intracranial pressure and the cerebral perfusion pressure remained above 85 mm Hg despite moderate reductions in arterial pressure. Frequently the action of the short-acting barbiturate in reducing intracranial pressure was transient, being limited, presumably, by redistribution of the drug.