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NEUROSURGICAL ANESTHESIA

Treatments to Support Blood Pressure Increases Bleeding and/or Decreases Survival in a Rat Model of Closed Head Trauma Combined with Uncontrolled Hemorrhage

Daniel Talmor, MD^*, Vlademir Merkind, MD, Alan A. Artru, MD, Oleg Shapiro, MD^*, Daniel Geva, MD^§, Leonid Roytblat, MD^*, and Yoram Shapira, MD, PhD^*

Divisions of *Anesthesiology and Neurosurgery, Ben-Gurion University of the Negev, Faculty of Health Sciences, Soroka Medical Center, Beer Sheva, Israel; Department of Anesthesiology, Kaplan Hospital, Rehovot, Israel; and §Department of Anesthesiology, University of Washington, Seattle, Washington

Address correspondence and reprint requests to Alan A. Artru, MD, Department of Anesthesiology, Box 356540, University of Washington School of Medicine, Seattle, WA 98195-6540. Address e-mail to artruaa{at}u.washington.edu

Hemorrhagic hypotension may aggravate the detrimental effects of head trauma on neurologic outcome. Our study examined whether using phenylephrine or large volumes of saline IV to increase mean arterial blood pressure (MAP) to 70, 80, or 90 mm Hg during the combination of head trauma and uncontrolled hemorrhage would improve neurologic outcome. Rats were assigned to one of 17 groups. In Groups 1–5, the variables were head trauma (yes/no), hemorrhage (yes/no), 0 or 3 mL saline per milliliter of blood lost, and no target MAP. In Groups 6–11, hemorrhage was or was not combined with head trauma, and large volumes of saline were given IV to achieve target MAPs of 70, 80, or 90 mm Hg. Groups 12–17 were similar to Groups 6–11 except that phenylephrine was used rather than saline to achieve target MAPs. Saline increased blood loss at 2 h to approximately 16 and 25 mL at a MAP of 80 and 90 mm Hg respectively, increased (worsened) the neurodeficit score but not cerebral edema at 24 h, and decreased survival rate at 2 and 24 h. Because phenylephrine was fatal for 62 of 63 rats, group mean values for blood loss, neurodeficit score, and brain tissue specific gravity could not be calculated. We conclude that supporting MAP with either phenylephrine or large volumes of saline worsened the neurodeficit score and/or survival and did not affect cerebral edema formation in our rat model of head trauma combined with hemorrhage.

Implications: The results of this study indicate that maintaining mean arterial blood pressure at 70, 80, or 90 mm Hg with either phenylephrine or large volumes of saline worsened the neurodeficit score and/or survival and did not affect cerebral edema formation in our rat model of head trauma combined with hemorrhage.

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				I. Eilig, M. Rachinsky, A. A. Artru, A. Alonchin, V. Kapuler, A. Tarnapolski, and Y. Shapira The Effect of Treatment with Albumin, Hetastarch, or Hypertonic Saline on Neurological Status and Brain Edema in a Rat Model of Closed Head Trauma Combined with Uncontrolled Hemorrhage and Concurrent Resuscitation in Rats Anesth. Analg., March 1, 2001; 92(3): 669 - 675. [Abstract] [Full Text] [PDF]

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