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INTRACRANIAL PRESSURE


Compiled by Mitzie Hemstreet, M.D. and John A. Ulatowski, M.D., Ph.D.
Johns Hopkins Medical Institutions, Baltimore, MD

Updated in 2002 by Sulpicio G. Soriano, M.D.
Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts

Review Articles

1. Brain Trauma Foundation: Indications for intracranial pressure monitoring. J Neurotrauma 13:667-679, 1996.

2. Brain Trauma Foundation: Intracranial pressure treatment threshold. J Neurotrauma 13:681-683, 1996.

3. Brain Trauma Foundation: Recommendations for intracranial pressure monitoring technology. J Neurotrauma 13:685-692, 1996.

4. Brain Trauma Foundation: Guidelines for cerebral perfusion pressure. J Neurotrauma 13:693-697, 1996.

5. Brain Trauma Foundation: Critical pathway for the treatment of established intracranial hypertension. J Neurotrauma 13:719-720, 1996.

6. Bingaman WE, Frank JI: Malignant cerebral edema and intracranial hypertension. Neurol Clin 13:479-509, 1995.

7. Chesnut RM: Medical management of severe head injury: present and future. New Horiz 3:581-593, 1995.

8. Friedman DI, Jacobson DM: Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 59:1492-5, 2002.

9. Grande PO, Asgeirsson B, Nordstrom CH: Volume-targeted therapy of increased intracranial pressure: the Lund concept unifies surgical and non-surgical treatments.
Acta Anaesthesiol Scand. 46:929-41, 2002.

10. Greenwald BM, Ghajar J, Notterman DA: Critical care of children with acute brain injury. Adv Pediatr 42:47-89, 1995.

11. Mazzola CA, Adelson PD: Critical care management of head trauma in children. Crit Care Med. 30 (11 Suppl):S393-401, 2002.

12. McGrath BJ, Matjasko MJ: Anesthesia and head trauma. New Horiz 3:523-533, 1995.

13. Pickard JD, Czosnyka M: Management of raised intracranial pressure. J Neurol Neurosurg Psych 56:845-858, 1993.

14. Robertson CS: Management of cerebral perfusion pressure after traumatic brain injury. Anesthesiology. 95:1513-7, 2001.

15. Smith RR, Caldemeyer KS: Increased intracranial pressure and the cerebrospinal fluid spaces. Semin Ultrasound CT MR 17:206-220, 1996.

16. Werner C: Effects of analgesia and sedation on cerebrovascular circulation, cerebral blood volume, cerebral metabolism and intracranial pressure. Anaesthesist 44(Suppl):S566-S572, 1995.

Monitoring Techniques

1. Avent RK, Charlton JD, Nagle HT, Johnson RN: A Monte Carlo technique for signal level detection in implanted intracranial pressure monitoring. Ann Biomed Eng 15:79-89, 1987.

2. Barlow P, Mendelow AD, Lawrence AE, Barlow M, Rowan JO: Clinical evaluation of two methods of subdural pressure monitoring. J Neurosurg 63:578-582, 1985.

3. Bochicchio M, Latronico N, Zappa S, Beindorf A, Candiani A: Bedside burr hole for intracranial pressure monitoring performed by intensive care physicians. A 5-year experience. Intensive Care Med 22:1070-1074, 1996.

4. Bunegin L, Albin MS, Rauschhuber R, Marlin AE: Intracranial pressure measurement from the anterior fontanelle utilizing a pneumoelectronic switch. Neurosurgery 20:726-731, 1987.

5. Chambers IR, Mendelow AD, Sinar EJ, Modha P: A clinical evaluation of the Camino subdural screw and ventricular monitoring kits. Neurosurgery 26:421-423, 1990.

6. Contant CF Jr, Robertson CS, Crouch J, Gopinath SP, Narayan RK, Grossman RG: Intracranial pressure waveform indices in transient and refractory intracranial hypertension. J Neurosci Meth 57:15-25, 1995.

7. Crutchfield JS, Narayan RK, Robertson CS, Michael LH: Evaluation of a fiberoptic intracranial pressure monitor. J Neurosurg 72:482-487, 1990.

8. Cruz J: Continuous versus serial global cerebral hemometabolic monitoring: applications in acute brain trauma. Acta Neurochir (Wien) 42:35-39, 1988.

9. Cruz J: On-line monitoring of global cerebral hypoxia in acute brain injury. Relationship to intracranial hypertension. J Neurosurg 79:228-233, 1993.

10. Droste DW, Krauss JK: Oscillations of cerebrospinal fluid pressure in nonhydrocephalic persons. Neurol Res 19:135-138, 1997.

11. Holloway KL, Barnes T, Choi S, Bullock R, Marshall LF, Eisenberg HM, Jane JA, Ward JD, Young HF, Marmarou A: Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients. J Neurosurg 85:419-424, 1996.

12. Jensen RL, Hahn YS, Ciro E: Risk factors of intracranial pressure monitoring in children with fiberoptic devices: a critical review. Surg Neurol 47:16-22, 1997.

13. Kaiai K, Samejima H, Ueda M, Ushikubo Y, Yanai H, Kukita C, Kato T: Intracranial pressure monitoring using a newly developed transducer-tipped ventricular drainage catheter. Neurol Med Chir (Tokyo) 38:238-240, 1998.

14. Kofke WA, Dong ML, Bloom M, Policare R, Janosky J, Sekhar L: Transcranial Doppler ultrasonography with induction of anesthesia for neurosurgery. J Neurosurg Anesthiol 6:89-97, 1994.

15. Magnano M, Albera R, Lacilla M, Gabini A, Naddeo M, Bruno D: Impedance measurement as a noninvasive technique for the monitoring of intracranial pressure variations. Audiology 33:237-243, 1994.

16. Mendelow AD, Rowan JO, Murray L, Kerr AE: A clinical comparison of subdural screw pressure measurements with ventricular pressure. J Neurosurg 58:45-50, 1983.

17. Miller JD, Bobo H, Kapp JP: Inaccurate pressure readings for subarachnoid bolts. Neurosurgery 19:253-255, 1986.

18. Nichols JS, Beel JA, Munro LG: Detection of impaired cerebral autoregulation using spectral analysis of intracranial pressure waves. J Neurotrauma 13:439-456, 1996.

19. North B, Reilly P: Comparison among three methods of intracranial pressure recording. Neurosurgery 18:730-732, 1986.

20. Ostrup RC, Luerssen TG, Marshall LF, Zornow MH: Continuous monitoring of intracranial pressure with a miniaturized fiberoptic device. J Neurosurg 67:206-209, 1987.

21. Raabe A, Totzauer R, Meyer O, Stockel R, Hohrein D, Schoche J: Reliability of epidural pressure measurements in clinical practice: behavior of three modern sensors during simultaneous ipsilateral intraventricular or intraparenchymal pressure measurement. Neurosurgery 43:306-311, 1998.

22. Resnick DK, Marion DW, Carlier P: Outcome analysis of patients with severe head injuries and prolonged intracranial hypertension. J Trauma 42:1108-1111, 1997.

Miscellaneous Pharmacologic Effects

1. Abou Madi M, Trop D, Abou Madi N, Ravussin P: Does a bolus of mannitol initially aggravate intracranial hypertension? A study at various PaCO2 tensions in dogs. Br J Anaesth 59:630-639, 1987.

2. Bundgaard H, Jensen K, Cold GE, Bergholt B, Frederiksen R, Pless S: Effects of perioperative indomethacin on intracranial pressure, cerebral blood flow, and cerebral metabolism in patients subjected to craniotomy for cerebral tumors. J Neurosurg Anesthesiol 8:273-279, 1996.

*3. Cottrell JE, Robustelli A, Post K, Turndorf H: Furosemide- and mannitol-induced changes in intracranial pressure and serum osmolality and electrolytes. Anesthesiology 47:28-30, 1977.

4. Cross DT 3rd, Moran CJ, Angtuaco EE, Milburn JM, Diringer MN, Dacey RG Jr: Intracranial pressure monitoring during intraarterial papaverine infusion for cerebral vasospasm. Am J Neuroradiol 19:1319-1323, 1998.

5. de Nadal M, Munar F, Poca MA, Sahuquillo J, Garnacho A, Rosselo J: Cerebral hemodynamic effects of morphine and fentanyl in patients with severe head injury: absence of correlation to cerebral autoregulation. Anesthesiology 92:11-19, 2000.

6. Favre JB, Ravussin P, Chiolero R, Bissonnette B: Hypertonic solutions and intracranial pressure. Schweiz Med Wochenschr 126:1635-1643, 1996.

7. Ghajar J, Hariri RJ, Narayan RK, Iacono LA, Firlik K, Patterson RH: Survey of critical care management of comatose, head-injured patients in the United States. Crit Care Med 23:560-567, 1995.

8. Gudeman SK, Miller JD, Becker DP: Failure of high-dose steroid therapy to influence intracranial pressure in patients with severe head injury. J Neurosurg 51:301-306, 1979.

9. Harrigan MR, Tuteja S, Neudeck BL: Indomethacin in the management of elevated intracranial pressure: a review. J Neurotrauma 14:637-650, 1997.

10. Jensen K, Ohrstrom J, Cold GE, Astrup J: The effects of indomethacin on intracranial pressure, cerebral blood flow and cerebral metabolism in patients with severe head injury and intracranial hypertension. Acta Neurochir 108:116-121, 1991.

11. Kelly DF: Steroids in head injury. New Horiz 3:453-455, 1995.

12. Mascia L, Andrews PJ, McKeating EG, Souter MJ, Merrick MV, Piper IR: Cerebral blood flow and metabolism in severe brain injury: the role of pressure autoregulation during cerebral perfusion pressure management. Inten Care Med 26:202-205, 2000.

13. McGraw CP, Alexander E Jr, Howard G: Effect of dose and dose schedule on the response of intracranial pressure to mannitol. Surg Neurol 10:127-130, 1978.

*14. Miller JD, Leech P: Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients. J Neurosurg 42:274-281, 1975.

15. Miller JD, Piper IR, Dearden NM: Management of intracranial hypertension in head injury: matching treatment with cause. Acta Neurochir (Wien) 57:152-159, 1993.

16. Nau R, Sander D, Klingelhofer J: Relationships between dopamine infusions and intracranial hemodynamics in patients with raised intracranial pressure. Clin Neurol Neurosurg 94:143-148, 1992.

17. Nilsson F, Bjorkman S, Rosen I, Messeter K, Nordstrom CH: Cerebral vasoconstriction by indomethacin in intracranial hypertension. An experimental investigation in pigs. Anesthesiology 83:1283-1292, 1995.

18. Pollay M, Fullenwider C, Roberts PA, Stevens FA: Effect of mannitol and furosemide on blood-brain osmotic gradient and intracranial pressure. J Neurosurg 59:945-950, 1983.

19. Qureshi AI, Suarez JI, Bhardwaj A, Mirski M, Schnitzer MS, Hanley DF, Ulatowski JA: Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: effect on intracranial pressure and lateral displacement of the brain. Critical Care Medicine 26:440-446, 1998.

20. Ravussin P, Abou Madi M, Archer D, Chiolero R, Freeman J, Trop D, De Tribolet N: Changes in CSF pressure after mannitol in patients with and without elevated CSF pressure. J Neurosurg 69:869-876, 1988.

21. Saul TG, Ducker TB: Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 56:498-503, 1982.

22. Schatzmann C, Heissler HE, Konig K, Klinge-Xhemajli P, Rickels E, Muhling M, Borschel M, Samii M: Treatment of elevated intracranial pressure by infusions of 10% saline in severely head injured patients. Acta Neurochir (Wein) 71:S31-S33, 1998.

*23. Schwartz ML, Tator CH, Rowed DW, Reid SR, Meguro K, Andrews DF: The University of Toronto head injury treatment study: a prospective, randomized comparison of pentobarbital and mannitol. Can J Neurol Sci 11:434-440, 1984.

24. Slavik RS, Rhoney DH: Indomethacin: a review of its cerebral blood flow effects and potential use for controlling intracranial pressure in traumatic brain injury patients. Neurol Res 21:491-499, 1999.

25. Suarez JI, Qureshi AI, Bhardwaj A, Williams WA, Schnitzer MS, Mirski M, Hanley DF, Ulatowski JA: Treatment of refractory intracranial hypertension with 23.4% saline. Critl Care Med 26:1118-1122, 1998.

*26. Walls RM: Rapid-sequence intubation in head trauma. Ann Emerg Med 22:1008-1013, 1993.

27. Zornow MH: Hypertonic saline as a safe and efficacious treatment of intracranial hypertension. J Neurosurg Anesthesiol 8:175-177, 1996.

Anesthetic Effects

*1. Adams RW, Cucchiara RF, Gronert GA, Messick JM, Michenfelder JD: Isoflurane and cerebrospinal fluid pressure in neurosurgical patients. Anesthesiology 54:97-99, 1981.

2. Artru AA: Nitrous oxide plays a direct role in the development of tension pneumocephalus intraoperatively. Anesthesiology 57:59-61, 1982.

*3. Artru AA: Relationship between cerebral blood volume and CSF pressure during anesthesia with isoflurane or fentanyl in dogs. Anesthesiology 60:575-579, 1983.

4. Artru AA: Relationship between cerebral blood volume and CSF pressure during anesthesia with halothane or enflurane in dogs. Anesthesiology 58:533-539, 1983.

5. Artru AA, Lam AM, Johnson JO, Sperry RJ: Intracranial pressure, middle cerebral artery flow velocity, and plasma inorganic fluoride concentrations in neurosurgical patients receiving sevoflurane and isoflurane. Anesth Analg 85:587-592, 1997.

6. Artru AA, Powers K, Doepfner P: CSF, sagittal sinus, and jugular venous pressures during desflurane or isoflurane anesthesia in dogs. J Neurosurg Anesthesiol 6:239-248, 1994.

7. Bekker AY, Mistry A, Ritter AA, Wolk SC, Turndorf H: Computer simulation of intracranial pressure changes during induction of anesthesia: comparison of thiopental, propofol, and etomidate. J Neurosurg Anesthesiol 11:69-80, 1999.

8. Bundgaar H, von Oettingen G, Larsen KM, Landsfeldt U, Jensen KA, Nielsen E, Cold GE: Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism. A dose-response study in patients subjected to craniotomy for cerebral tumours. Acrta Anaesthesiol Scand 42:621-627, 1998.

9. Chiolero RL, De Tribolet N: Sedatives and antagonists in the management of severely head-injured patients. Acta Neurochir 55(Suppl):43-46, 1992.

10. DiGiovanni AJ, Goodrick J, Neigh JL, Harp JR, Kennell EM: The effect of halothane anesthesia on intracranial pressure in the presence of intracranial hypertension. Anesth Analg 53:823-827, 1974.

11. Donegan MF, Bedford RF: Intravenously administered lidocaine prevents intracranial hypertension during endotracheal suctioning. Anesthesiology 52:516-518, 1980.

12. Drummond JC, Todd MM, Toutant SM, Shapiro HM: Brain surface protrusion during enflurane, halothane, and isoflurane anesthesia in cats. Anesthesiology 59:288-293, 1983.

13. Fitch W, Barker J, Jennett WB, McDowall DG: The influence of neuroleptanalgesic drugs on cerebrospinal fluid pressure. Br J Anaesth 41:800-806, 1969.

14. Fitch W, McDowall DG: Effect of halothane on intracranial pressure gradients in the presence of intracranial space-occupying lesions. Br J Anaesth 43:904-912, 1971.

15. Gardner AE, Dannemiller FJ, Dean D: Intracranial cerebrospinal fluid pressure in man during ketamine anesthesia. Anesth Analg 51:741-745, 1972.

16. Giffin JP, Cottrell JE, Shwiry B, Hartung J, Epstein J, Lim K: Intracranial pressure, mean arterial pressure, and heart rate following midazolam or thiopental in humans with brain tumors. Anesthesiology 60:491-494, 1984.

17. Grosslight K, Foster R, Colohan AR, Bedford RF: Isoflurane for neuroanesthesia: risk factors for increases in intracranial pressure. Anesthesiology 63:533-536, 1985.

18. Guy J, Hindman BJ, Baker KZ, Borel CO, Maktabi M, Ostapkovich N, Kirschner J, Todd MM, Fogarty-Mack P, Yancy V, Sokoll MD, McAllister A, Roland C, Young WL, Warner DS: Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions. Anesthesiology 86:514-524, 1997.

19. Henriksen HT, Jorgensen PB: The effect of nitrous oxide on intracranial pressure in patients with intracranial disorders. Br J Anaesth 45:486-492, 1973.

20. Herrick IA, Gelb AW, Manninen PH, Reichman H, Lownie S: Effects of fentanyl, sufentanil, and alfentanil on brain retractor pressure. Anesth Analg 72:359-363, 1991.

*21. Jennett WB, Barker J, Fitch W, McDowall DG: Effect of anaesthesia on intracranial pressure in patients with space-occupying lesions. Lancet 1:61-64, 1969.

22. Jung R, Shah N, Reinsel R, Marx W, Marshall W, Galicich J, Bedford R: Cerebrospinal fluid pressure in patients with brain tumors: impact of fentanyl versus alfentanil during nitrous oxide-oxygen anesthesia. Anesth Analg 71:419-422, 1990.

23. Lauer KK, Connolly LA, Schmeling WT: Opioid sedation does not alter intracranial pressure in head injured patients. Can J Anaesth 44:929-933, 1997.

24. Louis PT, Goddard-Finegold J, Fishman MA, Griggs JR, Stein F, Laurent JP: Barbiturates and hyperventilation during intracranial hypertension. Crit Care Med 21:1200-1206, 1993.

25. Lutz LJ, Milde JH, Milde LN: The response of the canine cerebral circulation to hyperventilation during anesthesia with desflurane. Anesthesiology 74:504-507, 1991.

26. Marshall LF, Shapiro HM: Barbiturate control of intracranial hypertension in head injury and other conditions: iatrogenic coma. Acta Neurol Scand (Wien) 64:156-157, 1977.

27. Mayberg TS, Lam AM, Matta BF, Domino KB, Winn HR: Ketamine does not increase cerebral blood flow velocity or intracranial pressure during isoflurane/nitrous oxide anesthesia in patients undergoing craniotomy. Anesth Analg 81:84-89, 1995.

28. Moss E: Alfentanil increases intracranial pressure when intracranial compliance is low. Anaesthesia 47:134-136, 1992.

29. Petersen KD, Landsfeldt U, Cold GE, Petersen CB, Mau S, Hauerberg J, Holst P, Olsen KS: Intracranial pressure and cerebral hemodynamic in patients with cerebral tumors: a randomized prospective study of patients subjected to craniotomy in propofol-fentanyl, isoflurane-fentanyl, or sevoflurane-fentanyl anesthesia. Anesthesiology. 98:329-36, 2003.

30. Pinaud M, Lelausque JN, Chetanneau A, Fauchoux N, Menegalli D, Souron R: Effects of propofol on cerebral hemodynamics and metabolism in patients with brain trauma. Anesthesiology 73:404-409, 1990.

31. Schalen W, Messeter K, Nordstrom CH: Complications and side effects during thiopentone therapy in patients with severe head injuries. Acta Anaesthesiol Scand 36:369-377, 1992.

32. Scheller MS, Todd MM, Drummond JC, Zornow MH: The intracranial pressure effects of isoflurane and halothane administered following cryogenic brain injury in rabbits. Anesthesiology 67:507-512, 1987.

33. Shapiro HM, Galindo A, Wyte SR, Harris AB: Rapid intraoperative reduction of intracranial pressure with thiopentone. Br J Anaesth 45:1057-1062, 1973.

34. Shin YS, Lee KY, Lee KJ, Kim MH, Kim JR, Park KW: Effects of propofol and thiopental sodium on the intracranial pressure under halothane or isoflurane anesthesia in the rabbit. Yonsei Med J 34:152-157, 1993.

35. Stocchetti N, Paparella A, Bridelli F, Bacchi M, Piazza P, Zuccoli P: Cerebral venous oxygen saturation studied with bilateral samples in the internal jugular veins. Neurosurgery 34:38-43, 1994.

36. Talke P, Caldwell J, Dodsont B, Richardson CA: Desflurane and isoflurane increase lumbar cerebrospinal fluid pressure in normocapnic patients undergoing transsphenoidal hypophysectomy. Anesthesiology 85:999-1004, 1996.

37. Talke P, Caldwell JE, Richardson CA. Sevoflurane increases lumbar cerebrospinal fluid pressure in normocapnic patients undergoing transsphenoidal hypophysectomy. Anesthesiology 91:127-130, 1999.

38. Todd MM, Warner DS, Sokoll MD, Maktabi MA, Hindman BJ, Scamman FL, Kirschner J: A prospective, comparative trial of three anesthetics for elective supratentorial craniotomy. Propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide. Anesthesiology 78:1005-1020, 1993.

39. Todd MM, Weeks J: Comparative effects of propofol, pentobarbital, and isoflurane on cerebral blood flow and blood volume. J Neurosurg Anesthesiol 8:296-303, 1996.

40. Van Hemelrijck J, Fitch W, Mattheussen M, Van Aken H, Plets C, Lauwers T: Effect of propofol on cerebral circulation and autoregulation in the baboon. Anesth Analg 71:49-54, 1990.

41. Vandesteene A, Trempont V, Engelman E, Deloof T, Focroul M, Schoutens A, de Rood M: Effect of propofol on cerebral blood flow and metabolism in man. Anaesthesia 43(Suppl):42-43, 1988.

42. Warner DS, Hindman BJ, Todd MM, Sawin PD, Kirchner J, Roland CL, Jamerson BD: Intracranial pressure and hemodynamic effects of remifentanil versus alfentanil in patients undergoing supratentorial craniotomy. Anesth Analg 83:348-353, 1996.

*43. Weeks JB, Todd MM, Warner DS, Katz J: The influence of halothane, isoflurane, and pentobarbital on cerebral plasma volume in hypocapnic and normocapnic rats. Anesthesiology 73:461-466, 1990.

44. Werner C, Kochs E, Bause H, Hoffman WE, Schulte am Esch J: Effects of sufentanil on cerebral hemodynamics and intracranial pressure in patients with brain injury. Anesthesiology 83:721-726, 1995.

45. Wooten TL, Lowrie CT: Comparison of cerebrospinal fluid pressure in propofol- and thiopental-anesthetized eucapnic dogs. Vet Surg 22:148-150, 1993.

46. Young WL: Effects of desflurane on the central nervous system. Anesth Analg 75:S32-S37, 1992.

47. Zornow MH, Scheller MS, Sheehan PB, Strnat MA, Matsumoto M: Intracranial pressure effects of desmedetomidine in rabbits. Anesth Analg 75:232-237, 1992.

Neuromuscular Blocking Drug Effects

1. Brown MM, Parr MJ, Manara AR: The effect of suxamethonium on intracranial pressure and cerebral perfusion pressure in patients with severe head injuries following blunt trauma. Eur J Anaesthesiol 13:474-477, 1996.

2. Cafiero T, Razzino S, Mastronardi P, Mazzarella B, De Vivo P: Mivacurium in patients with intracranial pathology. Minerva Anestesiol 65:81-85, 1999.

3. Fahy BG, Matjasko MJ: Disadvantages of prolonged neuromuscular blockade in patients with head injury. J Neurosurg Anesthiol 6:136-118, 1994.

4. Minton MD, Grosslight K, Stirt JA, Bedford RF: Increases in intracranial pressure from succinylcholine: prevention by prior nondepolarizing blockade. Anesthesiology 65:165-169, 1986.

5. Minton MD, Stirt JA, Bedford RF, Haworth C: Intracranial pressure after atracurium in neurosurgical patients. Anesth Analg 64:1113-1116, 1985.

6. Prielipp RC, Coursin DB: Sedative and neuromuscular blocking drug use in critically ill patients with head injuries. New Horiz 3:456-468, 1995.

7. Prielipp RC, Robinson JC, Wilson JA, MacGregor DA, Scuderi PE: Dose response, recovery, and cost of doxacurium as a continuous infusion in neurosurgical intensive care unit patients. Crit Care Med 25:1236-1241, 1997.

8. Rosa G, Orfei P, Sanfilippo M, Vilardi V, Gasparetto A: The effects of atracurium besylate (Tracrium) on intracranial pressure and cerebral perfusion pressure. Anesth Analg 65:381-384, 1986.

9. Schramm WM, Strasser K, Bartunek A, Gilly H, Spiss CK: Effects of rocuronium and vecuronium on intracranial pressure, mean arterial pressure and heart rate in neurosurgical patients. Br J Anaesth 77:607-611, 1996.

10. Schramm WM, Papousek A, Michalek-Sauberer A, Czech T, Illievich U: The cerebral and cardiovascular effects of cisatracurium and atracurium in neurosurgical patients. Anesth Analg 86:123-127, 1998.

11. Silber SH: Rapid sequence intubation in adults with elevated intracranial pressure: a survey of emergency medicine residency programs. Am J Emerg Med 15:263-267, 1997.

12. Stirt JA, Grosslight KR, Bedford RF, Vollmer D: "Defasciculation" with metocurine prevents succinylcholine-induced increases in intracranial pressure. Anesthesiology 67:50-53, 1987.

13. Stirt JA, Maggio W, Haworth C, Minton MD, Bedford RF: Vecuronium: effect on intracranial pressure and hemodynamics in neurosurgical patients. Anesthesiology 67:570-573, 1987.

14. Thiel A, Wyderka T, Wagner RM, Ebel H, Hempelmann G: Effects of pipecuronium and pancuronium on cerebrospinal fluid pressure in neurosurgical patients. Acta Anaesthesiol Belg 47:59-65, 1996.

15. Werba A, Klezl M, Schramm W, Langenecker S, Muller C, Gosch M, Spiss CK: The level of neuromuscular block needed to suppress diaphragmatic movement during tracheal suction in patients with raised intracranial pressure: a study with vecuronium and atracurium. Anaesthesia, 48:301-303, 1993.

16. Wilson JA, Branch CL Jr: Neuromuscular blockade in head-injured patients with increased intracranial pressure: continuous versus intermittent use. J Neurosurg Anesthiol 6:139-141, 1994.

Antihypertensive Drug Effects

1. Abdelwahab W, Frishman W, Landau A: Management of hypertensive urgencies and emergencies. J Clin Pharmacol 35:747-762, 1995.

2. Adams RE, Powers WJ: Management of hypertension in acute intracerebral hemorrhage. Crit Care Clin 13:131-161, 1997.

3. Asgeirsson B, Grande PO, Nordstrom CH, Berntman L, Messeter K, and Ryding E: Effects of hypotensive treatment with alpha 2-agonist and beta 1-antagonist on cerebral haemodynamics in severely head injured patients. Acta Anaesthesiol Scand 39:347-351, 1995.

4. Bedford RF, Dacey R, Winn HR, Lynch C III: Adverse impact of a calcium entry-blocker (verapamil) on intracranial pressure in patients with brain tumors. J Neurosurg 59:800-802, 1983.

*5. Cottrell JE, Gupta B, Rappaport H, Turndorf H, Ransohoff J, Flamm ES: Intracranial pressure during nitroglycerin-induced hypotension. J Neurosurg 53:309-311, 1980.

6. Favre JB, Gardaz JP, Ravussin P: Effect of clonidine on ICP and on the hemodynamic responses to nociceptive stimuli in patients with brain tumors. J Neurosurg Anesthesiol 7:159-167, 1995.

7. Hadley MN, Spetzler RF, Fifield MS, Bichard WD, Hodak JA: The effect of nimodipine on intracranial pressure. Volume-pressure studies in a primate model. J Neurosurg 67:387-393, 1987.

8. Hennes HJ, Jantzen JP: Effects of fenoldopam on intracranial pressure and hemodynamic variables at normal and elevated intracranial pressure in anesthetized pigs. J Neurosurg Anesthiol 6:175-181, 1994.

9. Hirose S, Handa Y, Kobayashi H, Kawano H, Nozaki J, Hayashi M: Effects of antihypertensive drugs on intracranial hypertension. Zentralbl Neurochir 52:69-75, 1991.

*10. Marsh ML, Aidinis SJ, Naughton KVH, Marshall LF, Shapiro HM: The technique of nitroprusside administration modifies the intracranial pressure response. Anesthesiology 51:538-541, 1979.

11. Michenfelder JD, Milde JH: The interaction of sodium nitroprusside, hypotension, and isoflurane in determining cerebral vasculature effects. Anesthesiology 69:870-875, 1988.

12. Nishikawa T, Omote K, Namiki A, Takahashi T: The effects of nicardipine on cerebrospinal fluid in humans. Anesth Analg 65:507-510, 1986.

13. Rogers MC, Hamburger C, Owen K, Epstein MH: Intracranial pressure in the cat during nitroglycerin-induced hypotension. Anesthesiology 51:227-229, 1979.

*14. Skinhoj E, Strandgaard S: Pathogenesis of hypertensive encephalopathy. Lancet 3:461-462, 1973.

15. Strandgaard S: Cerebral blood flow in the elderly: impact of hypertension and antihypertensive treatment. Cardiovasc Drugs Ther 4(Suppl):1217-1221, 1991.

16. Ter Minassian A, Beydon L, Decq P, Bonnet F: Changes in cerebral hemodynamics after a single dose of clonidine in severely head-injured patients. Anesth Analg 84:127-132, 1997.

17. Tietjen CS, Hurn P, Ulatowski JA, Kirsch JR: Treatment modalities for hypertensive patients with intracranial pathology: options and risks. Crit Care Med 24:311-322, 1996.

18. Tonnesen AS: Hemodynamic management of brain-injured patients. New Horiz 3:499-505, 1995.

19. Turner JM, Powell D, Gibson RM, McDowall DG: Intracranial pressure changes in neurosurgical patients during hypotension induced with sodium nitroprusside or trimetaphan. Br J Anaesth 49:419-425, 1977.

20. Van Aken H, Puchstein C, Anger C, Heinecke A, Lawin P: Changes in intracranial pressure and compliance during adenosine triphosphate-induced hypotension in dogs. Anesth Analg 63:381-385, 1984.

21. Van Aken H, Puchstein C, Hidding J: The use of labetalol in producing deliberate hypotension and its effects on intracranial pressure in dogs. Acta Anaesthesiol Belg 33:5-12, 1982.

Nonpharmacologic Treatment of Intracranial Hypertension

1.  Allen CH, Ward JD: An evidence-based approach to management of increased intracranial pressure. Crit Care Clin 3:485-495, 1988.

2. Carter BS, Ogilvy CS, Candia GJ, Rosas HD, Buonanno F: One-year outcome after decompressive surgery for massive nondominant hemispheric infarction. Neurosurgery 40:1168-1175, 1997.

3. Dam Hieu P, Sizun J, Person H, Besson G: The place of decompressive surgery in the treatment of uncontrollable post-traumatic intracranial hypertension in children. Childs Nerv Syst 12:270-275, 1996.

4. Dexter F: Research synthesis of controlled studies evaluating the effect of hypocapnia and airway protection on cerebral outcome. J Neurosurg Anesthesiol 9:217-222, 1997.

5. Ernst PS, Albin MS, Bunegin L: Intracranial and spinal cord hemodynamics in the sitting position in dogs in the presence and absence of increased intracranial pressure. Anesth Analg 70:147-153, 1990.

6. Kenning JA, Toutant SM, Saunders RL: Upright patient positioning in the management of intracranial hypertension. Surg Neurol 15:148-152, 1981.

7. Kerr ME, Brucia J: Hyperventilation in the head-injured patient: an effective treatment modality? Heart Lung 22:516-522, 1993.

8. Marion DW, Firlik A, McLaughlin MR: Hyperventilation therapy for severe traumatic brain injury. New Horiz 3:439-447, 1995.

9. Marion DW, Obrist WD, Carlier PM, Penrod LE, Darby JM: The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. J Neurosurg 79:354-362, 1993.

10. McGuire G, Crossley D, Richards J, Wong D: Effects of varying levels of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure. Crit Care Med 25:1059-1062, 1997.

11. Muizelaar JP, Marmarou A, Ward JD, Kontos HA, Choi SC, Becker DP, Gruemer H, Young HF: Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 75:731-739, 1991.

12. Polin RS, Shaffrey ME, Bogaev CA, Tisdale N, Germanson T, Bocchicchio B, Jane JA: Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41:84-92, 1997.

13. Rolighed Larsen JK, Haure P, Cold GE: Reverse Trendelenburg position reduces intracranial pressure during craniotomy. J Neurosurg Anesthesiol. 14(1):16-21, 2002.

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Pathophysiology

1. Cooper KR, Boswell PA, Choi SC: Safe use of PEEP in patients with severe head injury. J Neurosurg 63:552-555, 1985.

2.  Czosnyka M, Smielewski P, Piechnik S, Schmidt EA, Al-Rawi PG, Kirkpatrick PJ, Pickard JD: Hemodynamic characterization of intracranial pressure plateau waves in head-injury patients. J Neurosurg 91:11-19, 1999.

3. Gabrielsen TO, D'Alecy LG, Knake JE, Hildenbrand PG, Gebarski SS: Effect of head turning on blood flow in lateral sinuses of nonhuman primates. Am J Neuroradiol 4:1219-1221, 1983.

4. Gambardella G, De Blasi F, Caruso G, Zema A, Turiano F, Collufio D: Intracranial pressure, cerebral perfusion pressure, and SPECT in the management of patients with SAH Hunt and Hess grades I-II. Acta Neurochir 71:S215-S218, 1998.

5. Hudetz AG, Feher G, Weigle CG, Knuese DE, Kampine JP: Video microscopy of cerebrocortical capillary flow: response to hypotension and intracranial hypertension. Am J Physiol 268:H2202-H2210, 1995.

6. Karahalios DG, Rekate HL, Khayata MH, Apostolides PJ: Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology 46:198-202, 1996.

7.  Kerwin AJ, Croce MA, Timmons SD, Maxwell RA, Malhotra AK, Fabian TC: Effects of fiberoptic bronchoscopy on intracranial pressure in patients with brain injury: a prospective clinical study. J Trauma 48:878-883, 2000.

8.  Kolb JC, Summers RL, Galli RL: Cervical collar-induced changes in intracranial pressure. Am J Emerg Med 17:135-137, 1999.

9. Lipe HP, Mitchell PH: Positioning the patient with intracranial hypertension: how turning and head rotation affect the internal jugular vein. Heart Lung 9:1031-1037, 1980.

10. Malik AB: Pulmonary vascular response to increase in intracranial pressure: role of sympathetic mechanisms. J Appl Physiol 42:335-343, 1977.

11. Malozowski S, Tanner LA, Wysowski DK, Fleming GA, Stadel BV: Benign intracranial hypertension in children with growth hormone deficiency treated with growth hormone. J Pediatr 126:996-999, 1995.

12. Mavrocordatos P, Bissonnette B, Ravussin P: Effects of neck position and head elevation on intracranial pressure in anaesthetized neurosurgical patients: preliminary results. J Neurosurg Anesthesiol 12:10-14, 2000.

13. McNamara ME, Millman RP, Epstein MH, Fogel BS: The association of normal-pressure hydrocephalus with obstructive sleep apnea. J Geriatr Psychiatry Neurol 5:238-240, 1992.

14. Murr R, Stummer W, Schurer L, Polasek J: Cerebral lactate production in relation to intracranial pressure, cranial computed tomography findings, and outcome in patients with severe head injury. Acta Neurochir (Wien) 138:928-936, 1996.

15. Olafsson S, Gottstein J, Blei AT: Brain edema and intracranial hypertension in rats after total hepatectomy. Gastroenterology 108:1097-1103, 1995.

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18.  Schmidt B, Czosnyka M, Schwarze JJ, Sander D, Gerstner W, Lumenta CB, Pickard JD, Klingelhofer J: Cerebral vasodilatation causing acute intracranial hypertension: a method for noninvasive assessment. J Cereb Blood Flow Metab 19:990-996, 1999.

19. Schob OM, Allen DC, Benzel E, Curet MJ, Adams MS, Baldwin NG, Largiader F, Zucker KA: A comparison of the pathophysiologic effects of carbon dioxide, nitrous oxide, and helium pneumoperitoneum on intracranial pressure. Am J Surg 172:248-253, 1996.

20. Schwab S, Spranger M, Aschoff A, Steiner T, Hacke W: Brain temperature monitoring and modulation in patients with severe MCA infarction. Neurology 48:762-767, 1997.

21. Severinghaus JW: Hypothetical roles of angiogenesis, osmotic swelling, and ischemia in high-altitude cerebral edema. J Appl Physiol 79:375-379, 1995.

22. Stewart AR, Finer NN, Peters KL: Effects of alterations of inspiratory and expiratory pressures and inspiratory/expiratory ratios on mean airway pressure, blood gases, and intracranial pressure. Pediatrics 67:474-481, 1981.

23. Sutton LN, McLaughlin AC, Kemp W, Schnall MD, Cho BK, Langfitt TW, Chance B: Effects of increased ICP on brain phosphocreatine and lactate determined by simultaneous 1H and 31P NMR spectroscopy. J Neurosurg 67:381-386, 1987.

24. Tranquart F, de Bray JM, Berson M, Akoka S, Bodard S, Pourcelot L: Concurrent changes in intracranial pressure, cerebral blood flow velocity, and brain energy metabolism in rabbits with acute intracranial hypertension. Childs Nervous System 10:285-292, 1994.

25. Ungersbock K, Tenckhoff D, Heimann A, Wagner W, Kempski OS: Transcranial Doppler and cortical microcirculation at increased intracranial pressure and during the Cushing response: an experimental study on rabbits. Neurosurgery 36:147-156, 1995.

26. Unterberg A, Kiening K, Schmiedek P, Lanksch W: Long-term observations of intracranial pressure after severe head injury. The phenomenon of secondary rise of intracranial pressure. Neurosurgery 32:17-23, 1993.

27. Williams A, Coyne SM: Effects of neck position on intracranial pressure. Am J Crit Care 2:68-71, 1993.

Pressure and Historical

1. Cooper R, Hulme A: Intracranial pressure and related phenomena during sleep. J Neurol Neurosurg Psychiatry 29:564-570, 1966.

2. Cuneo RA, Caronna JJ, Pitts L: Upward transtentorial herniation, seven cases and a literature review. Archives Neurol 36:618-623, 1979.

3. Cushing H: Concerning a definite regulatory mechanism of the vasomotor centre which controls blood pressure during cerebral compression. Johns Hopkins Hosp Bull 12:290-292, 1901.

4. Cushing H: Some experimental and clinical observations concerning states of increased intracranial tension. Am J Med Sci 124:375-400, 1902.

5. Dearden NM, McDowall DG, Gibson RM: Assessment of Leeds device for monitoring intracranial pressure. J Neurosurg 60:123-129, 1984.

6. Gambardella G, d'Avella D, Tomasello F: Monitoring of brain tissue pressure with a fiberoptic device. Neurosurg 31:918-921, 1992.

7. Klingelhofer J, Conrad B, Benecke R, Sander D, Markakis E: Evaluation of intracranial pressure from transcranial Doppler studies in cerebral disease. J Neurol 235:159-162, 1988.

8. Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Neurol Scand 36(Suppl 149):1-193, 1960.

9. Lundberg N, Cronqvist S, Kjallquist A: Clinical investigations on interrelations between intracranial pressure and intracranial hemodynamics. Prog Brain Res 30:69-75, 1968.

10. Marmarou A, Anderson RL, Ward JD, Choi SC, Young JF, Eisenberg HM, Foules MA, Marshall LF, Jane JA: Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 75:S59-S66, 1991.

11. Marmarou A, Shulman K, LaMorgese J: Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg 43:523-534, 1975.

12. Mendelow AD, Rowan JO, Murray L, Kerr AE: A clinical comparison of subdural screw pressure measurements with ventricular pressure. J Neurosurg 58:45-50, 1983.

13. Meyer A: Herniation of the brain. Arch Neurol Psychiatry 4:387-400, 1920.

14. Quincke H: Die lumbarpunktion des hydrocephalus. Klin Wochenschr 28:929-933, 965-968, 1981.

15. Risberg J, Lundberg N, Ingvar DH: Regional cerebral blood volume during acute transient rises of the intracranial pressure (plateau waves). J Neurosurg 31:303-310, 1969.

16. Winn HR, Dacey RG, Jane JA: Intracranial subarachnoid pressure recording: experience with 650 patients. Surg Neurol 8:41-47, 1977.

17. Walsh P, Logan WJ: Continuous and intermittent measurement of intracranial pressure by Ladd monitor. J Pediatr 102:439-442, 1983.

18. Zidan AH, Girvin JP: Effect on the Cushing response of different rates of expansion of a supratentorial mass. J Neurosurg 49:61-70, 1978.


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