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Anesth Analg 2006;102:1823-1829
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000204259.88592.dd

NEUROSURGICAL ANESTHESIA

The Effects of Indomethacin on Intracranial Pressure and Cerebral Hemodynamics During Isoflurane or Propofol Anesthesia in Sheep with Intracranial Hypertension

Mads Rasmussen, MD, PhD*{dagger}, Richard N. Upton, BSc, PhD*, Cliff Grant, MMedSc*, Allison M. Martinez*, Georg E. Cold, MD, PhD{dagger}, and Guy Ludbrook, MD, FANZCA, PhD*

*Department of Anesthesia and Intensive Care, Royal Adelaide Hospital/University of Adelaide, North Terrace, Australia; and {dagger}Department of Neuroanesthesia, Århus University Hospital, Denmark

Address correspondence to Mads Rasmussen, MD, PhD, Department of Neuroanesthesia, Århus University Hospital, Nørrebrogade 44, 8000 Århus C., Denmark. Address e-mail to maras{at}as.aaa.dk.

The effect of indomethacin in reducing intracranial pressure (ICP) may be dependent on the choice of anesthetic regimen. We studied the effects of indomethacin on ICP and cerebral blood flow (CBF) during isoflurane or propofol anesthesia in a sheep model of intracranial hypertension. A crossover design was applied in which six sheep were anesthetized with isoflurane and propofol in a random order. Anesthetic depth was measured with response and state entropy. Changes in CBF, ICP, mean arterial blood pressure, arterio-venous oxygen difference, and Paco2 were measured at specific times before and after an IV indomethacin bolus (0.2 mg/kg). Response and state entropy values during anesthesia were similar in both groups. Isoflurane and propofol reduced CBF by 11% and 34%, respectively. Indomethacin caused a reduction in ICP within 15 s during both anesthetic regimens, with the decrease in ICP being significantly more pronounced during isoflurane (P = 0.009). In both anesthetic groups, indomethacin caused a simultaneous increase in mean arterial blood pressure and a further 17% versus 14% decrease in CBF from predrug values for isoflurane and propofol, respectively. The reduction in CBF was significantly more pronounced for propofol (P = 0.02). The effect on ICP, however, was most pronounced during isoflurane anesthesia. We suggest that the effect of indomethacin is partly mediated by an autoregulatory response.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.