CHANGES IN NEUROLOGIC STATUS AND INTRACRANIAL-PRESSURE ASSOCIATED WITH SODIUM-NITROPRUSSIDE ADMINISTRATION

Four patients with a hydrocephalus received sodium nitroprusside (SNP). All of them experienced increases in ICP (X̄ = 14 ± 4 torr), with three of four actually doubling their initial pressures. Patient 1, who received the only bolus SNP injection, had the greatest ICP increment (20 torr) without any change in BP. Patients 2 and 3, who had the lowest initial ICP values (9 and 11 torr, respectively), experienced no change in their states of consciousness, although their mean BP values decreased to less than those of the others. Patients 1 and 4, who had mild to moderate intracranial hypertension prior to administration of SNP, experienced significantly greater ICP peaks, marked by decreased level of consciousness and complaints of headache and dizziness, respectively. Patient 1, who responded to vocal stimuli prior to SNP administration did not respond to moderately painful stimuli after receiving the drug. With the appearance of clinical signs of intracranial decompensation, anesthesia was induced in each patient with thiopental. In no case were there any signs of brainstem compression or focal deficits. No significant difference in Pa(co2) before and after the SNP infusion was recorded for any patients. The results are discussed.