Utility Of Lumbar Drain In Achieving Brain Relaxation In Patients Undergoing Intracranial Vascular Aneurysmal Surgeries

Dr. Richa Agarwal; Dr. Pradip Kumar Bhattacharya; Dr. Santosh Kumar Bhaskar

Volume : V, Issue : II, February - 2015

Utility Of Lumbar Drain In Achieving Brain Relaxation In Patients Undergoing Intracranial Vascular Aneurysmal Surgeries

Dr. Richa Agarwal, Dr. Pradip Kumar Bhattacharya, Dr. Santosh Kumar Bhaskar

Abstract :

Background:The study was designed to ascertain the utility of lumbar drain in achieving ain relaxation intraoperatively in patients undergoing intra cranial vascular aneurysmal surgeries. Materials and methods: This prospective non–randomized study was conducted on 40 patients. After standard intravenous induction and securing the airway with endotracheal tube, patient was placed in lateral decubitus position and lumbar puncture was performed, usually at L4–5 interspace .The lumbar drain (LD) was attached to an external CSF drainage bag and ICP transducer. After placement of lumbar drain, the patient was placed in surgical position and MAP, HR, ICP, CPP, ETCO2 were recorded. Mannitol 20% was started immediately after positioning the patient in the dose of 1 gm/kg slowly within half an hour and MAP, HR, ICP, CPP and ETCO2 were again noted at interval of 10, 20, 30, 60, 120 minutes. Lumbar drain was closed for 120 minutes after the infusion of mannitol. Then lumbar drain was opened and was kept at the level of operating table. CSF drainage was carried out continuously and MAP, HR, ICP, CPP and ETCO2 were noted at every 10 min interval for half an hour. Duramater was opened after half an hour of opening the lumbar drain. Surgeon’s intraoperative impression of the fullness of the ain was recorded. Brain relaxation was assessed by surgeon on a four point scale as Relaxed, Satisfactory, Firm and Bulging. Results: In this study, 21% decrease in ICP was observed during two hours after giving mannitol whereas 43 % decrease in ICP was found following CSF drainage two hour after giving mannitol. CPP was decreased by 3 % within first 2 hours of giving mannitol infusion, though this decrease was not significant (p value >0.05) whereas CPP improved by 8 % (p value< 0.000) after lumbar drain. Brain was fully relaxed in 22 patients and was satisfactory in 16 patients. In only one patient firm ain was observed Conclusion: We conclude from this study that taking the help of lumbar drain for intracranial vascular surgery not only improves cereal hemodynamics,but also provides better intraoperative surgical exposure.