Sustained Intrathecal Administration of Nicardipine for Prevention of Cerebral Vasospasm Following Subarachnoid Hemorrhage and Operative Manipulation in Consideration of Nicardipine Delivery

Autor:	Itoh Masaki, Mabuchi Shoji, Tohyama Yoshihiro, Murai Hiroshi, Sugtyama Taku
Rok vydání:	2007
Předmět:	Subarachnoid hemorrhage medicine.diagnostic_test business.industry Nicardipine Cerebral arteries Vasospasm medicine.disease nervous system diseases Catheter Cerebral vasospasm Anesthesia Angiography cardiovascular system Medicine cardiovascular diseases business Carotid Cistern medicine.drug
Zdroj:	Surgery for Cerebral Stroke. 35:174-180
ISSN:	1880-4683 0914-5508
Popis:	We investigated the effect of sustained administration of intrathecal nicardipine, calcium antagonist, in 16 cases to prevent post-subarachnoid hemorrhage (SAH) vasospasm. Patients with SAH of Fisher CT Group 3 (15 cases) or Group 4 (1 case) underwent direct clipping surgery and the placement of the cisternal catheter. From 1-4 days after SAH onset, the nicardipine solution (0.09 mg/ml) was continuously injected through the cisternal catheter at the rate of 2 ml/h for 4-16 days. The vasospasm was evaluated from postoperative angiography performed 1 week after SAH onset. The ratios of diameter at internal carotid arteries (ICA) C1 portion, middle cerebral arteries (MCA) M1 portion and anterior cerebral arteries A1 portion were obtained from preoperative and post-operative angiograms. Mild localized vasospasm was observed in 5 cases. The ratios of diameter at C1, M1 and A1 were 1.15±0.19, 1.13±0.23 and 1.17±0.26, respectively. No symptomatic vasospasm was observed in any of the cases. These findings demonstrated that the vaso-dilative effect of nicardipine prevented the post SAH vasospasm of intracranial arteries at C1, M1 and A1. The mild angiographical vasospasm in the 5 cases was probably due to the insufficient delivery of nicardipine solution. Following the operative manipulation of the exposure of ICA and MCA with radical clot removal, administration of nicardipine solution through the catheter in the contralateral carotid cistern and draining from the catheter in ipsilateral sylvian cistern brought the widespread nicardipine delivery to peripheral arteries. Though further improvement of this method is required, sustained intrathecal administration of nicardipine effectively prevents vasospasm following SAH.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::6f0c765439c4d3ec726696137d8ef171 https://doi.org/10.2335/scs.35.174 Zobrazit plný text záznamu