Blood pressure response to administration of local anaesthetics with noradrenaline in craniotomies

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Abstract
Summary Infiltration with local anaesthetics with addition of adrenaline or noradrenaline has been used since 1910 prior to skin incision for craniotomy. In a controlled series of patients scheduled for intracranial operations, systemic blood pressure was measured intra-arterially after infiltration with 15–20 ml 0.5% lignocaine with noradrenaline 1 μ gr/ml. A marked increase in systemic blood pressure was seen (125% of values prior to infiltration). In a control series, where saline was injected, a slight fall in blood pressure was registered (p< 0.01). As hypertensive episodes increase intracranial pressure in patients with impaired cerebral autoregulation, or promote the risk of haemorrhage in aneurysm surgery, this technique is considered a hazard to patients undergoing intracranial operations.

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