Treatment of Subarachnoid Hemorrhage-Associated Delayed Cerebral Ischemia with Milrinone: A Review and Proposal
| Autor: | Yasser B. Abulhasan, Hormuzdiyar H. Dasenbrock, Michael J Schontz, Mohammad Ali Aziz-Sultan, Mark R. Angle, Rose Du, Saef Izzy, Sarah E. Nelson, Nirav J. Patel, Galen V. Henderson, David Y. Chung, Thomas D Bernier, Thabele M Leslie-Mazwi, Steven K. Feske |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Subarachnoid hemorrhage Ischemia Article law.invention Brain Ischemia 03 medical and health sciences 0302 clinical medicine Cerebral vasospasm Randomized controlled trial 030202 anesthesiology law medicine Humans Multicenter Studies as Topic Vasospasm Intracranial Dosing Intensive care medicine Randomized Controlled Trials as Topic business.industry Subarachnoid Hemorrhage medicine.disease Anesthesiology and Pain Medicine Etiology Milrinone Surgery Neurology (clinical) Complication business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | J Neurosurg Anesthesiol |
| Popis: | Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage continues to be associated with high levels of morbidity and mortality. This complication had long been thought to occur secondary to severe cerebral vasospasm, but expert opinion now favors a multi-factorial etiology, opening the possibility of new therapies. To date, no definitive treatment option for DCI has been recommended as standard of care, highlighting a need for further research into potential therapies. Milrinone has been identified as a promising therapeutic agent for DCI, possessing a mechanism of action for the reversal of cerebral vasospasm as well as potentially anti-inflammatory effects to treat the underlying etiology of DCI. Intra-arterial and intravenous administration of milrinone has been evaluated for the treatment of DCI in single center case series and cohorts and appears safe and associated with improved clinical outcomes. Recent results have also brought attention to the potential outcome benefits of early, more aggressive dosing and titration of milrinone. Limitations exist within the available data, however, and questions remain about the generalizability of results across a broader spectrum of patients suffering from DCI. The development of a standardized protocol for milrinone use in DCI, specifically addressing areas requiring further clarification, is needed. Data generated from a standardized protocol may provide the impetus for a multi-center, randomized control trial. We review the current literature on milrinone for the treatment of DCI and propose a preliminary standardized protocol for further evaluation of both safety and efficacy of milrinone. |
| Databáze: | OpenAIRE |
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