Intracranial Hypertension and Brain Oedema in Albino Rabbits. Part 3: Effect of Acute Simultaneous Diuretic and Barbiturate Therapy

Overview

Journal Acta Neurochir (Wien)

Specialty Neurosurgery

Date 1982 Jan 1

PMID 6808809

Authors

C H Millson

H E James

H M Shapiro

R LAURIN

Affiliations

Soon will be listed here.

Abstract

Increased intracranial pressure due to brain oedema was produced in albino rabbits by combining a cryogenic lesion in the left hemisphere with the intraperitoneal administration of 6-aminonicotinamide (cytotoxic agent). The following parameters were assessed: intracranial pressure (ICP), systolic arterial pressure (SAP), central venous pressure (CVP), EEG, brain water and electrolyte content, gross pathology, and blood brain barrier integrity. Acute therapy to reduce ICP was performed by administering a bolus of mannitol (1 gm/kg) and 30 minutes later, also in bolus, frusemide (5 mg/kg). Immediately following the administration of mannitol an infusion of pentobarbitone was commenced; this was continued for one hour so that a total of 10 mg/kg was administered. There was a 50% reduction of ICP at one hour from initiation of treatment. The brains of the animals were extracted immediately upon cessation of therapy (pentobarbitone) and they revealed a significant reduction of water content for the right, uninjured, hemisphere only, when compared to controls; a slight but not significant reduction of the brain sodium and potassium was noted in both hemispheres. There was no change noted in the gross pathology and extent of blood brain barrier breakdown. In all animals epinephrine infusion had to be administered for between 20 and 30 minutes to maintain a SAP over 80 torr. There seems to be no advantage in the simultaneous administration of barbiturates and diuretics for the control of ICP due to brain oedema.

References

KLATZO I . Presidental address. Neuropathological aspects of brain edema. J Neuropathol Exp Neurol. 1967; 26(1):1-14. DOI: 10.1097/00005072-196701000-00001. View

Baethmann A, van HARREVELD A . Water and electrolyte distribution in gray matter rendered edematous with a metabolic inhibitor. J Neuropathol Exp Neurol. 1973; 32(3):408-23. DOI: 10.1097/00005072-197307000-00006. View

Leech P, Miller J . Intracranial volume--pressure relationships during experimental brain compression in primates. 3. Effect of mannitol and hyperventilation. J Neurol Neurosurg Psychiatry. 1974; 37(10):1105-11. PMC: 494852. DOI: 10.1136/jnnp.37.10.1105. View

Fenske A, Samii M, Reulen H, Hey O . Extracellular space and electrolyte distribution in cortex and white matter of dog brain in cold induced oedema. Acta Neurochir (Wien). 1973; 28(1):81-94. DOI: 10.1007/BF01405405. View

Michenfelder J, THEYE R . Cerebral protection by thiopental during hypoxia. Anesthesiology. 1973; 39(5):510-7. DOI: 10.1097/00000542-197311000-00010. View

Shapiro H, Galindo A, Wyte S, Harris A . Rapid intraoperative reduction of intracranial pressure with thiopentone. Br J Anaesth. 1973; 45(10):1057-62. DOI: 10.1093/bja/45.10.1057. View

Bruce D, Raphaely R, Goldberg A, Zimmerman R, Bilaniuk L, Schut L . Pathophysiology, treatment and outcome following severe head injury in children. Childs Brain. 1979; 5(3):174-91. DOI: 10.1159/000119817. View

Shapiro H, Wyte S, Loeser J . Barbiturate-augmented hypothermia for reduction of persistent intracranial hypertension. J Neurosurg. 1974; 40(1):90-100. DOI: 10.3171/jns.1974.40.1.0090. View

Reulen H . Vasogenic brain oedema. New aspects in its formation, resolution and therapy. Br J Anaesth. 1976; 48(8):741-52. DOI: 10.1093/bja/48.8.741. View

10.

Baethmann A, Reulen H, Brendel W . [The effect of the Antimetabolite 6-aminonicotinamide (6-ANA) on the water- and electrolyte content in the brain of rats and its inhibition by niacin]. Z Gesamte Exp Med Einschl Exp Chir. 1968; 146(3):226-40. View

11.

Cottrell J, Robustelli A, Post K, Turndorf H . Furosemide- and mannitol-induced changes in intracranial pressure and serum osmolality and electrolytes. Anesthesiology. 1977; 47(1):28-30. DOI: 10.1097/00000542-197707000-00006. View

12.

Go K, ZIJLSTRA W, Flanderijn H, Zuiderveen F . Circulatory factors influencing exudation in cold-induced cerebral edema. Exp Neurol. 1974; 42(2):332-8. DOI: 10.1016/0014-4886(74)90030-2. View

13.

Harbaugh R, James H, Marshall L, Shapiro H, LAURIN R . Acute therapeutic modalities for experimental vasogenic edema. Neurosurgery. 1979; 5(6):656-65. DOI: 10.1227/00006123-197912000-00002. View

14.

Bruce D, Langfitt T, Miller J, Schutz H, Vapalahti M, Stanek A . Regional cerebral blood flow, intracranial pressure, and brain metabolism in comatose patients. J Neurosurg. 1973; 38(2):131-44. DOI: 10.3171/jns.1973.38.2.0131. View

15.

Vassallo A, Cioffi F, Strukelj S . [Furosemide in the treatment of brain edema during surgical intervention]. Minerva Neurochir. 1971; 15(3):165-7. View

16.

Clasen R, Pandolfi S, Casey Jr D . Furosemide and pentobarbital in cryogenic cerebral injury and edema. Neurology. 1974; 24(7):642-8. DOI: 10.1212/wnl.24.7.642. View

17.

Marshall L, Smith R, Shapiro H . The outcome with aggressive treatment in severe head injuries. Part II: acute and chronic barbiturate administration in the management of head injury. J Neurosurg. 1979; 50(1):26-30. DOI: 10.3171/jns.1979.50.1.0026. View

18.

KLATZO I, Piraux A, LASKOWSKI E . The relationship between edema, blood-brain-barrier and tissue elements in a local brain injury. J Neuropathol Exp Neurol. 1958; 17(4):548-64. DOI: 10.1097/00005072-195810000-00002. View

19.

Bakay L, Haque I . MORPHOLOGICAL AND CHEMICAL STUDIES IN CEREBRAL EDEMA. I. COLD INDUCED EDEMA. J Neuropathol Exp Neurol. 1964; 23:393-418. DOI: 10.1097/00005072-196407000-00001. View

20.

Wise B, Chater N . The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebro-spinal-fluid pressure. J Neurosurg. 1962; 19:1038-43. DOI: 10.3171/jns.1962.19.12.1038. View