The effects of verapamil on cerebrospinal fluid pressure in surgical patients

The effects of verapamil upon cerebrospinal fluid pressure (CSFP) were studied in twenty surgical patients without intracranial pathology who were divided into two groups of ten patients each: verapamil 0.075mg·kg^–1 was given in group 1 and 0.15mg·kg^–1 was given in group 2. A spinal needle was inserted into the subarachnoid space to permit continuous measurement of CSFP. Intravenous verapamil as a bolus produced a statistically significant increase in CSFP: from 6.0 ± 3.5 (mean ± SD) to 10.5 ± 4.3mmHg in group 1 (P < 0.01), and from 6.2 ± 3.1 to 12.6 ± 3.8mmHg in group 2 (P < 0.01). CSFP after verapamil attained its maximum in 0.5–1.5min, then gradually returned to control levels. Changes in CSFP were always associated with statistically significant decreases in arterial blood pressure and cerebral perfusion pressure, while the heart rate showed variable changes. It is concluded that a clinical dose of verapamil showed variable changes. It is concluded that a clinical dose of verapamil (0.075–0.15mg·kg^–1) has no neurological side effects in patients without intracranial hypertension. However, it must be emphasized that verapamil may increase CSFP to undesirable levels and should be avoided in patients with compromised intracranial compliance.(Nishikawa T, Namiki A: The effects of verapamil on cerebrospinal fluid pressure in surgical patients. J Anesth 1: 132–136, 1987)