The effects of indomethacin on intracranial pressure and cerebral haemodynamics in patients undergoing craniotomy: A randomised prospective study

We compared the effects of indomethacin (bolus of 0.2 mg.kg-1 followed by an infusion of 0.2 mg.kg-1.h-1) and placebo on intracranial pressure and cerebral haemodynamics in 30 patients undergoing craniotomy for supratentorial brain tumours under propofol and fentanyl anaesthesia. Indomethacin was given before induction of anaesthesia and the infusion was terminated after opening of the dura. Subdural intracranial pressure was measured through the first burr hole and before opening the dura. Cerebral blood flow velocity, cerebral perfusion pressure, jugular bulb oxygen saturation, arterio-venous oxygen difference and carbon dioxide reactivity were measured; dural tension and the degree of brain swelling were estimated. Before induction of anaesthesia, indomethacin administration was associated with a significant decrease in cerebral blood flow velocity compared with placebo. After induction of anaesthesia, cerebral blood flow velocity and mean arterial blood pressure decreased significantly in both groups. Indomethacin was not associated with a decrease in intracranial pressure. There were no differences in cerebral perfusion pressure, dural tension or degree of brain swelling between the two groups. Carbon dioxide reactivity measured after induction of anaesthesia was significantly lower in the indomethacin group (p < 0.05). After removal of the bone flap, no significant difference in carbon dioxide reactivity was observed. We suggest that these findings are explained by propofol-induced cerebral vasoconstriction.