Use of Intrathecal Nicardipine for Aneurysmal Subarachnoid Hemorrhage-Induced Cerebral Vasospasm

作者：Ehtisham As'ad^*; Taylor Scott; Bayless Linda; Samuels Owen B; Klein Michael W; Janzen Jeff M

来源：Southern Medical Journal, 2009, 102(2): 150-153.

DOI：10.1097/smj.0b013e31818f8ba4

• intrathecal
• nicardipine
• subarachnoid hemorrhage
• transcranial Doppler
• vasospasm

Background: Cerebral vasospasm leading to delayed ischemia is a common and serious complication of aneurysmal subarachnoid hemorrhage that often results in increased morbidity and mortality. Treatments for cerebral vasospasm. including triple-H therapy (therapeutic hypervolemia, hypertension, and hemodilution), nimodipine, balloon angioplasty, and intra-arterial vasodilators have limitations in their efficacy and safety profiles. Nicardipine, a calcium channel blocker, is available for intravenous administration for blood pressure reduction. A recent Study reported its efficacy in the treatment of cerebral vasospasm when given intrathecally (IT). We present our experiences with IT nicardipine for treatment of cerebral vasospasm.
Methods: IT nicardipine was administered to six patients with aneurysmal subarachnoid hemorrhage after prophylactic and aggressive therapeutic management for vasospasm failed.
Results: In these patients, IT nicardipine treatment was followed within 8 hours by a 43.1 /- 31.0 cm/s decrease in middle cerebral arterial flow velocity, as measured by transcranial Doppler ultrasound.
Conclusions: Based on these positive results, we believe that larger scale Studies evaluating the safety and efficacy of IT nicardipine for the management of cerebral vasospasm are warranted.

• 出版日期2009-2