Monitoring of intracranial pressure after open-heart surgery.

Brain damage following open-heart surgery is receiving increasing attention. Efforts are being made to improve the setting for cardiac surgery so as to avoid such complications. When they occur, their recognition is retrospective, when the cerebral lesion is inevitable. Because heavy sedation is necessary, clinical supervision with respect to brain function is both difficult and unreliable in the early postoperative period. We therefore submitted 34 selected patients to neurosurgical intensive care supervision. The measures included postoperative monitoring of intracranial epidural pressure (EDP), of arterial blood pressure (BP) and of central venous pressure (CVP). In 25 patients there was rise in EDP during the first postoperative hours. Six of these patients received mannitol treatment and in three of them barbiturate was additionally given, in order to reduce EDP and improve the cerebral perfusion pressure (CPP = BP-EDP). Nevertheless EDP progressed to brain tamponade six days postoperatively in one case. In patients with raised EDP, weaning from the ventilator should be postponed until EDP has almost normalized. The EDP recording is a valuable guide in the postoperative management of the individual patient.