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Lidocaine or Thiopental for Rapid Control of Intracranial Hypertension?

Robert F. Bedford, MD^*, John A. Persing, MD, Louis Pobereskin, MD, and Albert Butler, MD

*Assistant Professor of Anesthesiology and Neurological Surgery The Departments of Anesthesiology and Neurological Surgery, University of Virginia Medical Center, Charlottesville, Virginia 22908. Research Fellow, Department of Neurological Surgery, The Departments of Anesthesiology and Neurological Surgery, University of Virginia Medical Center, Charlottesville, Virginia 22908. Associate Professor of Neurological Surgery, The Departments of Anesthesiology and Neurological Surgery, University of Virginia Medical Center, Charlottesville, Virginia 22908.

Abstract

The effectiveness of intravenously administered lidocaine for rapid control of acute intracranial hypertension was compared to the effectiveness of thiopental in 20 patients with brain tumors undergoing craniotomy. Despite normal radial arterial and intracranial pressures (ICP) after induction of N2O-O2-morphine anesthesia, mean ICP increased from 13.8 torr ± 1.5 SE to 31 torr ± 2.3 SE (p < 0.001) in response to application of a pin-holder or scalp incision. To treat the elevated ICP a bolus injection of lidocaine, 1.5 mg/kg IV, was given to 10 patients, whereas the other 10 received thiopental, 3 mg/kg IV. Lidocaine reduced ICP 15.7 torr ± 5.6 SE (p < 0.025) but did not significantly affect mean arterial pressure. In contrast, thiopental lowered ICP 18.4 torr ± 9.6 SE (p < 0.02) and also lowered mean arterial pressure by 26.1 torr ± 9.6 SE (p < 0.025). Mean time for injection of medication to ICP nadir was 66 seconds ± 10 SE after lidocaine versus 48 seconds ± 9 SE after thiopental (p > 0.20). It is concluded that lidocaine is as effective as thiopental for rapid reduction of intraoperative intracranial hypertension but that it causes less cardiovascular depression. Lidocaine may be of particular benefit to patients with both intracranial hypertension and marginal circulatory function.

Key Words: ANESTHESIA: neurosurgical • BRAIN: intracranial pressure • ANESTHETICS, Local: lidocaine • ANESTHETICS, Intravenous: thiopental.