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Effects of cisatracurium on cerebral and cardiovascular hemodynamics in patients with severe brain injury
Author(s) -
SCHRAMM W. M.,
JESENKO R.,
BARTUNEK A.,
GILLY H.
Publication year - 1997
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.1399-6576.1997.tb04651.x
Subject(s) - medicine , cerebral perfusion pressure , anesthesia , intracranial pressure , cerebral blood flow , bolus (digestion) , sedation , glasgow coma scale , blood pressure , mean arterial pressure , midazolam , hemodynamics , middle cerebral artery , neurointensive care , hyperventilation , heart rate , cardiology , ischemia
Background : For neuroanesthesia and neurocritical care the use of drugs that do not increase or preferentially decrease intracranial pressure (ICP) or change cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) are preferred. The current study investigates the effects of a single rapid bolus dose of cisatracurium on cerebral blood flow velocity, ICP, CPP, mean arterial pressure (MAP) and heart rate (HR) in 24 mechanically ventilated patients with intracranial hypertension after severe brain trauma (Glasgow coma scale 6) under continuous sedation with sufentanil and midazolam. Methods : Patients were randomly assigned to receive either 2XED95 (n=12) or 4XED95 (n=12) of cisatracurium as a rapid i.v. bolus injection. Before and after bolus administration mean cerebral blood flow velocity (BFV, cm/s) was measured in the middle cerebral artery using a 2–MHz transcranial Doppler sonography system, ICP (mm Hg) was measured using an extradural probe, and MAP (mm Hg) and HR (b/min) were measured during a study period of 20 min. Cerebral perfusion pressure (CPP=MAP–ICP) was also calculated. Results : Our data show that a single bolus dose of up to 4 × ED95 cisatracurium caused no significant (P<0.05) changes in BFV, ICP, CPP, MAP and HR. Possible histamine‐related events were not observed during the study. Conclusions : The results from this study suggest that cisatracurium is a safe neuromuscular blocking agent for use in adult severe brain–injured patients with increased ICP under mild hyperventilation and continuous sedation.