| Safety of intraventricular sodium nitroprusside and thiosulfate for the treatment of cerebral vasospasm in the intensive care unit setting. | |
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MedLine Citation:
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PMID: 11823657 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: We have recently reported the safety of intraventricular sodium nitroprusside for the treatment of cerebral ischemia from vasospasm. Treatments have been accompanied previously by cerebral angiography to gauge treatment effect on established vasospasm. We presently report the safe coadministration of intraventricular sodium nitroprusside and thiosulfate in 10 patients with secured ruptured cerebral aneurysms in the intensive care unit, without the use of cerebral angiography for vasospasm treatment. METHODS: Patients were considered eligible for treatment on the basis of subarachnoid hemorrhage grade or manifestation of cerebral vasospasm by either transcranial Doppler ultrasonography (TCD) or neurological examination criteria. The route of administration was intraventricular, by way of ventriculostomy. Two separate protocols differing in dosage frequency were used, depending on the presence or absence of a new neurological deficit. Response to treatment was measured by TCD and neurological criteria. RESULTS: Good outcome was observed in 7 of 8 vasospasm patients presenting with clinical subarachnoid hemorrhage grade > or =3. Four patients demonstrated reversal of well-defined neurological deficits (hemiparesis, paraparesis) in the setting of treatment. Seven patients demonstrated a decrease in TCD velocities within 1 hour of treatment. Two patients died: 1 from intractable vasospasm despite maximal medical management and angioplasty and 1 from pulmonary causes. One episode of hypotension occurred in the setting of a high dose of medication. This responded promptly to medical management. Prolonged intracranial hypertension did not occur; modest elevations of both intracranial pressure and mean arterial blood pressure were observed when nausea and vomiting were associated with treatment, which occurred commonly in awake subjects. CONCLUSIONS: Intraventricular sodium nitroprusside with thiosulfate may be safely administered in the intensive care unit setting without the requirement of cerebral angiography to guide the effects of therapy. |
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Authors:
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Jeffrey E Thomas; Gerri McGinnis |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 33 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2002 Feb |
Date Detail:
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Created Date: 2002-02-01 Completed Date: 2002-02-21 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 486-92 Citation Subset: IM |
Affiliation:
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Division of Neurosurgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque 87131, USA. tokyojet14@netscape.net |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Brain / blood supply, drug effects, surgery Catheterization Drug Therapy, Combination Female Humans Infusion Pumps Injections, Intraventricular Intensive Care* Male Middle Aged Neurologic Examination Nitroprusside / administration & dosage*, adverse effects Subarachnoid Hemorrhage / complications*, diagnosis Survival Rate Thiosulfates / administration & dosage*, adverse effects Treatment Outcome Ultrasonography, Doppler, Transcranial Vasospasm, Intracranial / complications, diagnosis, therapy* Ventriculostomy |
| Chemical | |
Reg. No./Substance:
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0/Thiosulfates; 15078-28-1/Nitroprusside; 7772-98-7/sodium thiosulfate |
| Comments/Corrections | |
Comment In:
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Stroke. 2002 Apr;33(4):1165-6; author reply 1165-6
[PMID:
11935079
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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