Effect of Intra-arterial Nimodipine on Cerebral Oxygen Saturation and Systemic Hemodynamic Indices in Patients With Cerebral Vasospasm: A Prospective Cohort Study

Abstract

Background: Intra-arterial nimodipine (IaN) is used in the management of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). The impact of IaN therapy on regional cerebral oxygen saturation (rScO2) assessed by near infra-red spectroscopy, and dynamic cardiac indices, is currently unknown. This study assessed the effect of IaN on rScO2 and systemic hemodynamic indices during IaN therapy for cerebral vasospasm after aSAH. Methods: This prospective cohort study was conducted in 20 patients over sixteen month period after ethics committee approval and informed consent. Patients with angiographic evidence of vasospasm received IaN 3mg over 30 minutes in the spastic vessels. Data regarding rScO2 heart rate (HR), mean blood pressure (MBP) cardiac index (CI), stroke volume index (SVI), stroke volume variation (SVV), and total peripheral resistance index (TPRI) were collected during IaN treatment. The primary outcome measure was change in rScO2 after IaN therapy. Results: There was no significant change from baseline in ipsilateral and contralateral rScO2 after IaN administration (mean difference [MD], 0.2; 95% confidence interval [CI], −2.1 to 1.6; P=0.804, and 1.3; −1.1 to 3.8; P=0.276, respectively). There was a significant decrease in MBP and TPRI (MD, −12.4; 95% CI, −6.6 to −18.2; P<0.001, and −674.3; −374.9 to −973.7; P<0.001, respectively) and increase in SVI and CI (MD, 7.5; 95% CI, 14.4 to 0.6; P=0.035 and 0.7; 0.9 to 0.4; P<0.001, respectively) after IaN therapy. HR and SVV were unchanged. Conclusions: IaN for aSAH-related cerebral vasospasm did not improve rScO2 but was associated with significant systemic hemodynamic effects, including a decrease in MBP and TPRI. These hemodynamic changes might offset any potential effects of IaN to improve rScO2.

Effect of Preanesthetic Fluid Loading on Postinduction Hypotension and Advanced Cardiac Parameters in Patients with Chronic Compressive Cervical Myelopathy: A Randomized Controlled Trial

“…The NICOM device works on the principle of bioreactance. 12 Changes in the intrathoracic blood volume alter the electrical capacitance and inductance properties (bioreactance) of the chest. A 75-kHz current is applied and the relative phase shift of the transthoracic voltage is measured.…”

Clinical Outcome in Cerebral Vasospasm Patients Treated with and without Intra-Arterial Nimodipine Infusion

“…After publication of the study by Biondi et al, many other studies were published. [6][7][8][9][10][11][12][13][14][15][16][17][18] Before our study began, there was only one single-arm prospective study (Hänggi et al) 8 that performed intra-arterial nimodipine in 26 patients with medical refractory CV. Hänggi et al con-cluded that intra-arterial nimodipine might have benefits in angiographic and clinical outcomes, but only temporarily.…”

“…6 Since then, intra-arterial nimodipine injection has been used increasingly and many series were published. [7][8][9][10][11][12][13][14][15][16][17][18] However, there was no randomized controlled trial (RCT) in the literature.…”