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Local anesthesia prevents hypertension following application of the Mayfield skull‐pin head holder
Author(s) -
Levin R.,
Hesselvik J. F.,
Kourtopoulos H.,
Vavruch L.
Publication year - 1989
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1989.tb02907.x
Subject(s) - medicine , mepivacaine , anesthesia , fentanyl , isoflurane , blood pressure , mean arterial pressure , heart rate , epinephrine , saline , bupivacaine , surgery
A marked hypertensive response is often seen when the Mayfield skull‐pin device is applied to stabilize the head of the anesthetized patient for neurosurgery. In a prospective, blinded and randomized trial, 10 patients received an infiltration block of 0.5% mepivacaine with epinephrine 5 μg/ml (3 ml at each pin site) 1 min before the Mayfield holder was applied. Ten patients received normal saline and served as controls. All patients were under general anesthesia induced with sodium pentothal, fentanyl and pancuronium, and maintained with isoflurane in nitrous oxide/oxygen and increments of fentanyl. In the control group, there were significant increases in mean arterial pressure (mean increase 43%, P <0.001) and heart rate (15%, P < 0.01) at 0.5, 1 and 2 min after application. In the mepivacaine group, no significant changes occurred. Infiltration of local anesthetic with epinephrine can thus safely protect against potentially dangerous increases in arterial pressure when the Mayfield holder is used.