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Effects of intubation technique on intracranial pressure: a cadaveric study

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Abstract

Patients are at risk of increased intracranial pressure (ICP) during manipulation for endotracheal intubation. The aim of this cadaveric study was to quantify this relationship. Five fresh frozen adult cadaveric heads were used. The internal carotid artery (ICA) and internal jugular vein (IJV) were dissected bilaterally. All vessels were occluded on the right side. To mimic central venous pressures, the left IJV was cannulated and filled with water to maintain a pressure of approximately 7 cm H2O. The ICA cannula was attached to an oscillating water pump. Next, an ICP monitor was placed. Normophysiological volumes of water were infused to maintain normal ICP. Baseline ICP and IJV pressures were recorded. The heads were then placed in the sniffing position and in neutral position for nasal intubation, and finally an oral endotracheal tube was placed using standard head/neck maneuvers. The ICP was recorded. Mean baseline ICP was 13 mmHg (range 4–18 mmHg) and mean IJV pressure was 6 cm H2O. In the sniffing position, ICP increased in all specimens by a mean of 5 mmHg. In the neutral position, after intubation, the ICP increased in all specimens by a mean of 3 mmHg. Nasal intubation resulted in an increase in four of the five specimens. The mean increase in ICP with this maneuver was 2 mmHg. We present a cadaveric model of ICP measurement during neck manipulation using intracranial fluid dynamics. The ICP increased consistently. Following clinical studies, physicians involved in intubating patients with concern for raised ICP should change the technique to avoid complications.

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Data availability

Please contact authors for data requests (Juan Jose Osorio Cardona, MD; email address: jcardona2@tulane.edu).

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Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge, which can then improve patient care. Therefore, these donors and their families deserve our highest gratitude [18].

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Authors and Affiliations

  1. Department of Neurological Surgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, 70112, USA

    Erin McCormack, Aimee Aysenne, Juan J. Cardona, Aaron S. Dumont & R. Shane Tubbs

  2. Department of Neurological Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA

    Erin McCormack, Cuong J. Bui & R. Shane Tubbs

  3. Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Arada Chaiyamoon

  4. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada

    R. Shane Tubbs

  5. Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

  6. Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

  7. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

  8. University of Queensland, Brisbane, Australia

    R. Shane Tubbs

Authors
  1. Erin McCormack
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  2. Aimee Aysenne
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  3. Juan J. Cardona
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  4. Arada Chaiyamoon
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  5. Cuong J. Bui
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  6. Aaron S. Dumont
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  7. R. Shane Tubbs
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Contributions

Erin McCormack: writing—original draft, conceptualization, and formal analysis. Aimee Aysenne: writing—review and editing, conceptualization, and formal analysis. Juan J. Cardona: writing—review and editing, investigation, and formal analysis. Arada Chaiyamoon: writing—review and editing, investigation, and resources. Cuong J. Bui: conceptualization, methodology, investigation, and writing—review and editing. Aaron S. Dumont: methodology, writing—review and editing, resources, and investigation. R. Shane Tubbs: conceptualization, methodology, investigation, and writing—review and editing.

Corresponding author

Correspondence to Juan J. Cardona.

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As our study used cadavers, our institution does not require an Institutional Review Board approval and is, thus, exempt.

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The authors declare no competing interests.

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McCormack, E., Aysenne, A., Cardona, J.J. et al. Effects of intubation technique on intracranial pressure: a cadaveric study. Neurosurg Rev 46, 88 (2023). https://doi.org/10.1007/s10143-023-01996-4

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  • DOI: https://doi.org/10.1007/s10143-023-01996-4

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