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The use of indomethacin to treat acute rises of intracranial pressure and improve global cerebral perfusion in a child with head trauma
Author(s) -
IMBERTI R.,
BELLINZONA G.,
ILARDI M.,
BRUZZONE P.,
PRICCA P.
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.tb04738.x
Subject(s) - medicine , cerebral perfusion pressure , intracranial pressure , head trauma , perfusion , cerebral trauma , anesthesia , head (geology) , surgery , geomorphology , geology
Background: The use of vasoconstrictors (e.g. dihydroergotamine, indomethacin) for the treatment of increased intracranial pressure (ICP) secondary to brain trauma is controversial. In particular, it has been suggested that vasoconstrictors be employed only for intracranial hypertension secondary to hyperemia, when venous jugular bulb saturation (SjO 2 ) is >75%. Method We administered indomethacin as a bolus i.v. (5–10 mg) on 18 occasions to a multiple‐injured 3‐year‐old child with acute rises of ICP secondary to severe brain trauma (GCS score 7) determining a large hypodensity area in and swelling of the right hemisphere. Results: Before indomethacin administration the average of mean ICP was 68.1 ± 10.8 (SD) mm Hg (range 47–84) and the cerebral perfusion pressure (CCP) was 38.4±10.4 mm Hg (range 30–65). In response to indomethacin, ICP dropped in a few seconds to 22.7±5.6 and CCP increased to 82.4±6.1 mm Hg ( P <0.001), while the mean arterial pressure remained unchanged. On 6 occasions SjO 2 was also evaluated immediately before and 5 and 10 min after indomethacin administration. Before indomethacin administration, SjO 2 values were within the normal range on 2 occasions and abnormally low on four. SjO 2 increased from the mean value of 45.6215.7 to 59.828.9 (after 5 min) and 60.6212.4% (after 10 min) ( P < 0.01 versus pre‐indomethacin). At the same time the cerebral venous pH increased from 7.4320.01 to 7.4550.01 ( P =0.01). These findinge suggest that the global cerebral perfusion was improved. Eighteen days after injury the child was awake and was discharged from the ICU. Conclusion: To our knowledge, increase of SjO, in response to indomethacin has not been previously reported. Although great caution is necessary in the use of indomethacin for the treatment of ICE these findings suggest that indomethacin can be useful for the treatment of acute rises of ICP compromising severely the CCP, even if SjO, is normal or abnormally low. Under these circumstances, indomethacin can improve the global cerebral perfusion.