Are Slow Waves of Intracranial Pressure Suppressed by General Anaesthesia?
Intracranial Pressure & Neuromonitoring XVI
Acta neurochirurgica Supplement, January 2018
Despina Afroditi Lalou, Marek Czosnyka, Joseph Donnelly, Andrea Lavinio, John D. Pickard, Matthew Garnett, Zofia Czosnyka
Slow waves of intracranial pressure (ICP) are spontaneous oscillations with a frequency of 0.3-4 cycles/min. They are often associated with pathological conditions, following vasomotor activity in the cranial enclosure. This study quantifies the effects of general anaesthesia (GA) on the magnitude of B-waves compared with natural sleep and the conscious state. Four groups of 30 patients each were formed to assess the magnitude of slow waves. Group A and group B consisted of normal pressure hydrocephalus (NPH) patients, each undergoing cerebrospinal fluid (CSF) infusion studies, conscious and under GA respectively. Group C comprised conscious, naturally asleep hydrocephalic patients undergoing overnight ICP monitoring; group D, which included deeply sedated head injury patients monitored in the intensive care unit (ICU), was compared with group C. The average amplitude for group A patients was higher (0.23 ± 0.10 mmHg) than that of group B (0.15 ± 0.10 mmHg; p = 0.01). Overnight magnitude of slow waves was higher in group C (0.20 ± 0.13 mmHg) than in group D (0.11 ± 0.09 mmHg; p = 0.002). Slow waves of ICP are suppressed by GA and deep sedation. When using slow waves in clinical decision-making, it is important to consider the patients' level of consciousness to avoid incorrect therapeutic and management decisions.
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