One hundred cases of children in Edinburgh who underwent ventricular pressure monitoring for diverse indications have been discussed in detail and examples of their pressure tracings illustrated. This and other studies have now established that I.C.P. monitoring is a useful clinical tool. The technique employed has been justified from both a theoretical and practical standpoint and other methods of monitoring I.C.P. reviewed from the medical literature with their relative advantages and disadvantages. There is a place for I.C.P. measurement in suspect neonates by means of fontanometry; in hydrocephalic children by monitoring from ventriculostomy reservoirs; in head injury by way of the epidural or subarachnoid space; in childhood encephalopathies and other causes of brain swelling by epidural monitoring and for the continual assessment of the child in whom R.I.C.P. may be an on-going problem by means of a teletransducer. This work has afforded me the opportunity also to report related areas of interest. Firstly, the effect of I.C.P. on monoamine metabolites in children's C.S.F. with little correlation being found but a probable additional increase in one metabolite. Secondly, the effect of various types of seizures increasing the I.C.P. had not been previously reported. And, thirdly, the fascinating effect of sleep in I.C.P. with cyclical pressure variations occurring in all cases and exaggerated pressure responses and wave forms when there is existing R.I.C.P. I have put forward an hypothesis for this sleep effect based on pressure and polygraphic recordings. Lastly the chapter on anaesthesia adds some weight to other studies that caution the use of ketamine in cases of R.I.C.P., but confirms its use otherwise. These studies have however raised doubts about its convulsant action and I have shown the previously overlooked effect of intubation on I.C.P. and described a momentary pressure reflex associated with spreading the vocal cords, which together with the sleep effect, may be related to the Sudden Infant Death Syndrome.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:657841 |
| Date | January 1979 |
| Creators | Minns, Robert Anthony |
| Publisher | University of Edinburgh |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/1842/18452 |
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