03 January 2025 : Review article
Skeletal Muscle Relaxants and Their Impact on Intracranial Pressure in Neurosurgery
Łukasz Grabarczyk
ABCDEFG 1, Huang Wen-Tau ABCDEF 2, Małgorzata Rymsza ABCDEF 2, Agnieszka Stankiewicz ABCDEF 2, Marta Dobrzeniecka-Al Dhaif ABCDEF 2, Maciej Szewczyk ABCDEFG 3*
DOI: 10.12659/MSM.946569
Med Sci Monit 2025; 31:e946569
Introduction
Symptoms of Increased Intracranial Pressure
Assessment of High Intracranial Pressure
Treatment Methods for Increased Intracranial Pressure
Succinylcholine’s Characteristics and Use in Patients Undergoing Neurosurgery
Characteristics of Benzylisoquinoline
Characteristics of Atracurium
Atracurium’s Effect on Intracranial Pressure and Use in Neurosurgery
Characteristics of Cisatracurium
Use of Cisatracurium in Neurosurgery
Mivacurium’s Characteristics and Impact on Intracranial Pressure in Patients Undergoing Neurosurgery
Aminosteroid Neuromuscular Blocking Agents
Characteristics of Pipecuronium
Characteristics of Pancuronium
Comparison of Use of Pipecuronium and Pancuronium in Neurosurgery
Vecuronium’s Characteristics and Use in Neurosurgery
Characteristics of Rocuronium
Rocuronium’s Use in Neurosurgery
Reversal Agents
Characteristics of Neostigmine
Characteristics of Sugammadex
Use of Sugammadex and Neostigmine in Neurosurgery Patients
Conclusions
Future Directions
References
Table 2 Systemic and cerebral effects of chosen muscle relaxants.
| Class of drug | Name of drug | Systemic effects | Brain effects |
|---|---|---|---|
| Depolarizing muscle relaxants | Succinylcholine | ||
| Non-depolarizing muscle relaxant | Pancuronium | ||
| AtracuriumCisatracurium | |||
| Mivacurium | |||
| Pipecuronium, VecuroniumRocuronium | |||
| BP – blood pressure; CBF – cerebral blood flow; ICP – intracranial pressure; CBV – cerebral blood volume; CPP – cerebral perfusion pressure; CSFP – cerebrospinal fluid pressure. | |||