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document
Effects of perioperative indomethacin on intracranial pressure , cerebral blood flow , and cerebral metabolism in patients subjected to craniotomy for cerebral tumors . This study was carried out to evaluate the effects of perioperative indomethacin on intracranial pressure ( ICP ) , cerebral blood flow ( CBF ) , and cerebral metabolism . Twenty patients subjected to craniotomy for supratentorial cerebral tumors were anesthetized with thiopental , fentanyl , nitrous oxide , and isoflurane . A PaCO2 level averaging 4.8 kPa ( median ) was achieved . The patients were randomized to intravenous indomethacin 50 mg or placebo administrated after exposure of the dura . ICP was measured continuously subdurally with a 22-gauge canula connected to a transducer . CBF and the arteriovenous difference of oxygen ( AVDO2 ) were measured twice , before and after indomethacin/placebo administration . A significant decrease in ICP from 6.5 to 1.5 mm Hg ( median ) was found after indomethacin administration . This decrease was caused by a significant decrease in CBF associated with a significant increase in AVDO2 . Indomethacin did not affect the cerebral metabolic rate of oxygen , the arteriovenous difference of lactate , or the lactate/oxygen index , suggesting that indomethacin did not provoke global cerebral ischemia . In the indomethacin group , dura was sufficiently relaxed in eight of nine patients and dura was opened without the occurrence of cerebral swelling . In one patient , mannitol treatment was necessary to prevent dural tightness . In the placebo group , mannitol supplemented with hypocapnia was applied in five patients . These findings suggest that perioperative treatment with indomethacin is an excellent treatment of intracranial hypertension during normocapnic isoflurane anesthesia for craniotomy .
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Intervention_Pharmacological
indomethacin
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Intervention_Pharmacological
anesthetized with thiopental , fentanyl , nitrous oxide , and isoflurane .
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Intervention_Pharmacological
intravenous indomethacin 50 mg
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Intervention_Control
placebo administrated after exposure of the dura
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Intervention_Physical
ICP was measured continuously subdurally with a 22-gauge canula connected to a transducer
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Intervention_Pharmacological
indomethacin
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Outcome_Physical
intracranial pressure
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Outcome_Physical
cerebral blood flow
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Outcome_Physical
cerebral metabolism
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Outcome_Other
effects
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Outcome_Physical
intracranial pressure ( ICP )
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Outcome_Physical
cerebral blood flow ( CBF )
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Outcome_Physical
cerebral metabolism
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Outcome_Physical
ICP
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Outcome_Physical
CBF
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Outcome_Physical
arteriovenous difference of oxygen
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Outcome_Physical
ICP
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Outcome_Physical
CBF
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Outcome_Physical
AVDO2
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Outcome_Physical
cerebral metabolic rate of oxygen
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Outcome_Physical
arteriovenous difference of lactate ,
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Outcome_Physical
lactate/oxygen index
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Outcome_Physical
cerebral swelling
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Outcome_Physical
dural tightness
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Participant_Condition
craniotomy for cerebral tumors
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Participant_Sample-size
Twenty
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Participant_Condition
craniotomy for supratentorial cerebral tumors
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Participant_Sample-size
five