From the FDA Drug Label
When increased ICP is suspected, hyperventilation and hypocarbia should accompany the administration of propofol injectable emulsion Reduction of intracranial pressure and brain mass: Adults: 0.25 to 2 g/kg body weight as a 15% to 25% solution administered over a period of 30 to 60 minutes
- What not to do in case of raised ICP post neck dissection:
- Give steroids: The provided treatment options do not include giving steroids, which suggests that this is not a recommended course of action.
- Other options like taking to HDU, monitoring ICP, and giving saline IV are not directly addressed as incorrect in the context of the provided information, but giving steroids is explicitly not included in the treatment. 1 2
From the Research
In a patient with raised intracranial pressure (ICP) following neck dissection, the most critical step is to avoid administering steroids, as they are contraindicated due to their ineffective reduction of ICP in acute scenarios and potential to worsen outcomes through immunosuppression and hyperglycemia. The appropriate management includes taking the patient to HDU/ICU, monitoring ICP, and administering IV fluids like saline. Treatment should focus on:
- Elevating the head
- Ventilation with permissive hyperventilation to maintain normal mean arterial pressure
- Osmotic diuretics such as mannitol (typically 0.25-1 g/kg IV) or hypertonic saline (3% solution) 3, 4 Sedation with propofol helps reduce cerebral metabolic demands, and anticonvulsants may be needed to prevent seizures which could worsen ICP. The goal of management is to reduce intracranial volume while maintaining cerebral perfusion pressure, achieved through decreasing cerebral blood volume, reducing CSF volume, or decreasing brain tissue volume through osmotic agents. According to the most recent and highest quality study, the use of pharmacologic interventions such as opioids, sedatives, osmotic diuretics, hypertonic saline solutions, and barbiturates may be used to normalize ICP and prevent secondary injury 5. However, it is essential to prioritize the patient's individual needs and tailor the treatment approach accordingly, as suggested by the evidence-based review of intraoperative management of ICP and brain bulk 6.