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NEUROSURGICAL ANESTHESIA

Intrathecal Lidocaine Prevents Cardiovascular Collapse and Neurogenic Pulmonary Edema in a Rat Model of Acute Intracranial Hypertension

Sean R.R. Hall, MSc^*, Louie Wang, MD, FRCPC, Brian Milne, MD, FRCPC, Sally Ford, MD, and Murray Hong, PhD^*

Departments of *Pharmacology & Toxicology, Anesthesiology, and Pathology, Queen’s University, Kingston, Ontario, Canada

Address correspondence and reprint requests to Murray Hong, PhD, Department of Anesthesiology, Kingston General Hospital, 76 Stuart St., Kingston, Ontario, Canada K7L 2V7. Address e-mail to mglh{at}post.queensu.ca

Sympathetic hyperactivity during sudden intracranial hypertension leads to cardiovascular instability, myocardial dysfunction, and neurogenic pulmonary edema. Because spinal anesthesia is associated with sympatholysis, we investigated the protective effects of intrathecal lidocaine in a rodent model. Halothane-anesthetized rats were given a 10-µL intrathecal injection of saline (n = 10) or lidocaine 1% (n = 6). A subdural balloon catheter was inflated for 60 s to produce intracranial hypertension. Hemodynamics were monitored, and hearts and lungs were harvested for histological examination. In Saline versus Lidocaine-Treated rats, peak mean arterial blood pressure during balloon inflation was 115 ± 4 mm Hg versus 78 ± 8 mm Hg (P < 0.05), mean arterial blood pressure 30 min after balloon deflation was 47 ± 2 mm Hg versus 67 ± 3 mm Hg (P < 0.05), and lung weight was 1.54 ± 0.03 g versus 1.41 ± 0.04 g (P < 0.05), respectively. Cardiac dysrhythmias and electrocardiographic changes were more frequent in the Saline-Treated group (P < 0.05). Saline-Treated rats had extensive, hemorrhagic pulmonary edema, whereas the Lidocaine-Treated rats had only patchy areas of lung abnormality. Histological changes in the myocardium were rare, and no difference was found between the two groups. We conclude that intrathecal lidocaine prevents cardiovascular collapse and neurogenic pulmonary edema in a rat model of acute intracranial hypertension.

IMPLICATIONS:In a rat model of intracranial balloon inflation, intrathecal lidocaine prevented cardiovascular collapse and neurogenic pulmonary edema. Descending neural pathways are involved in the development of cardiopulmonary complications associated with acute intracranial hypertension.

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