The effect of reversal of myoneural blockade on cerebrospinal fluid pressure following cerebral aneurysm surgery
Fawcett, W.J.; Chung, R.A.; Fairley, C.J.; Hollway, T.E.
European Journal of Anaesthesiology 12(6): 591-595
1995
ISSN/ISBN: 0265-0215 PMID: 8665882 Document Number: 442499
Drugs with a depolarizing action at the myoneural junction may cause a rise in intracranial pressure. Neostigmine, which is commonly used to reverse residual myoneural blockade, has a depolarizing action, and yet its effect on intracranial pressure is unknown. Lumbar cerebrospinal fluid pressure, which mirrors intracranial pressure, was determined in 12 patients undergoing cerebral aneurysm surgery. Cerebrospinal fluid pressure was measured during dense myoneural blockade and after its reversal with neostigmine. These effects on cerebrospinal fluid pressure were compared with those produced when the arterial partial pressure of carbon dioxide (PaCO-2) rose from 4 to 5 kPa. After reversal of myoneural block, there was a small (nonsignificant) change in cerebrospinal fluid pressure from 3.6 to 4.3 kPa and a larger (significant) rise in cerebrospinal fluid pressure to 9.7 kPa when the PaCO-2 was allowed to rise. In this group of patients, reversal of myoneural blockade with neostigmine causes no significant change in cerebrospinal fluid pressure.