The Influence of Sodium Nitroprusside Administration on the Occurence and Abolishion of Vasospasms in Subarachnoid Haemorrhage: a Prospective Interventional Study

Overview

Objective:
The aim of the study was to evaluate the effect of preventive and therapeutic use of subarachnoid sodium nitroprusside (SNP) administration in patients with non-traumatic subarachnoid haemorrhage (SAH) in the condition of a multimodal brain tissue monitoring.

Design:
Prospective interventional study.

Setting:
Depts. of Anaesthesiology/CCM and Neurosurgery, Charles University, the 3rd Faculty of Medicine, Prague.

Material and Methods:
All consecutive adult patients admitted in the period 2000–2003 with non-traumatic SAH, Hunt-Hess grade I–IV indicated for neurosurgical intervention were enrolled to the study. In the post -operative period they were treated by controlled mechanical ventilation and a triple-H protocol with a calcium channel blocker. The subarachnoid preventive dose of SNP was administered as a standard medication (initial dose of 1mg) by a catheter inserted to the basal cistern during the neurosurgical procedure. The timing of following doses was directed by dynamic changes of respiratory parameters of the brain tissue in the region of interest assessed by the NeurotrendTM Multiparameter Sensor and changes of a blood flow velocity on the level of the Willisi circuit measured by the transcranial doppler ultrasonography.

Results:
17 patients were enrolled to the study (M/F 11/6, age 27–77 yrs, x = 52.94, SD = 11.34), all survived. No brain infarction developed in studied groups. The increase blood flow velocity was found in three pa tients.

Conclusion:
The preventive subarachnoidal use of the SNP in the bolus dose of 1 mg into the basal cisterns is a perspective preventive strategy. Its efficacy has to be proved on a greater number of patients in the future. The multimodal brain tissue monitoring enables the low-dose titration of the SNP therapy. The therapeutical use of the SNP requires the increase of the application rate.

Key words:
nitric oxide – sodium nitroprusside – subarachnoid administration – cerebral vasospasm – subarachnoid haemorrhage – preventive treatment