The Effects of Nitroglycerin on Cerebrospinal Fluid Pressure in Awake and Anesthetized Humans

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Abstract
The effects of nitroglycerin on cerebrospinal fluid pressure (CSFP) and arterial blood pressure were studied in 56 patients with normal CSFP. Thirty-two patients were studied while awake, and 24 while anesthetized with thiamylal, nitrous oxide and oxygen. Nitroglycerin administered as an iv bolus produced marked increases in CSFP and decreases in arterial pressure in all patients studied. Maximal changes in CSFP seen at 1–2 min following nitroglycerin, 4 μg/kg and 8 μg/kg, were 190 ± 8.3 (mean ± SE) and 286 ± 53.6 per cent of control, respectively. The increases in CSFP were transient and return to control values occurred within 2–3 min after the injection. The increase in CSFP and the decrease in arterial blood pressure occurred virtually simultaneously. There were no statistically significant differences in the changes in CSFP and arterial pressure between awake and anesthetized subjects. These data suggest that in patients with decreased intracranial compliance, nitroglycerin may cause undesirable increases in CSFP; further this effect may not be blocked by prior administration of drugs such as thiamylal.