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© 2016 Journal of Neuroanaesthesiology and Critical Care | Published by Wolters Kluwer Medknow | 200/112 (150) mmHg with the HR drop of 39/min. When we mentioned the haemodynamic changes to the surgical colleagues, they informed us that they had just carried out scalp infiltration with 7 ml of 2% xylocaine with adrenaline (1 in 200,000). This hypertensive crisis was treated with additional propofol, fentanyl and labetalol, which brought the BP down to 160/80 mmHg. As there was sudden bradycardia along with hypertension, the possibility of seizures (high-grade temporal lesion) or pin site extradural haematoma causing Cushing’s response was our differential diagnosis. Since, the ICP reducing effect is better and the cerebral perfusion pressure is higher with total intravenous anaesthesia (TIVA) compared to inhalational agent,[1] we had changed the inhalational anaesthetics to TIVA.

Does bradycardia and hypertension always equal to Cushing’s response during supratentorial craniotomy?