Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study

Soliman, Rabie; Zohry, Gomaa

doi:10.1016/j.bjane.2018.09.004

Cited by 16 publications

(13 citation statements)

References 34 publications

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“…Study and participant characteristics are provided in Supplemental Table 2. Settings included Europe (six studies)[11–16], Asia (eight studies)[17–24], North America (two studies)[15,25], South America (one study)[26] and North Africa (one study)[27]. There were nine single centre studies[13,14,16,17,23–27] and eight multi-centre studies[11,12,15,18–22].…”

Section: Resultsmentioning

confidence: 99%

“…Publication dates ranged from 1989 to 2019. Thirteen studies looked at pharmacological interventions for aSAH[11,12,25–27,14,16–19,21–23]; the other four studies looked at surgical or interventional radiology treatments[15,20,24]. Eleven studies used vasospasm (angiographic or symptomatic) as their primary outcome[11,16,27,17–20,22,24–26], four studies used delayed ischaemic neurological deficit (DIND) or cerebral infarction[12–14,21] and three studies looked at clinical outcome using the Glasgow outcome scale (GOS) or the modified Rankin scale (mRS)[15,18,23].…”

Section: Resultsmentioning

confidence: 99%

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The fragility index in randomised controlled trials of interventions for aneurysmal subarachnoid haemorrhage: a systematic review

Ramesh

Munby

Thomas

2021

Preprint

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Background Fragility analysis supplements the p-value and risk of bias assessment in the interpretation of results of randomised controlled trials. In this systematic review we determine the fragility index (FI) and fragility quotient (FQ) of randomized trials in aneurysmal subarachnoid haemorrhage. Methods This is a systematic review registered with PROSPERO (ID: CRD42020173604). Randomised controlled trials in adults with aneurysmal subarachnoid haemorrhage were analysed if they reported a statistically significant primary outcome of mortality, function (e.g. modified Rankin Scale), vasospasm or delayed neurological deterioration. Results We identified 3809 records with 17 randomized trials selected for analysis. The median fragility index was 3 (inter-quartile range 0-5) and the median fragility quotient was 0.012 (IQR 0-0.034). Six of nineteen trial outcomes (31.6%) had an fragility index of 0. In seven trials (36.8%), the number of participants lost to follow-up was greater than or equal to the fragility index. Only 17.6% of trials are at low risk of bias. Conclusions Randomised controlled trial evidence supporting management of aneurysmal subarachnoid haemorrhage is weaker than indicated by conventional analysis using p-values alone. Increased use of fragility analysis by clinicians and researchers could improve the translation of evidence to practice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The fragility index in randomised controlled trials of interventions for aneurysmal subarachnoid haemorrhage: a systematic review

Ramesh

Munby

Thomas

2021

Preprint

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“…Cerebral vasospasm occurs in approximately 70% of patients with aneurysmal subarachnoid hemorrhage, which is the main cause of morbidity and mortality in these patients. This fact has led to research focused on the prevention of vasospasm as a measure to reduce irreversible sequelae in these patients [60][61][62]. It has been shown that MgSO 4 can decrease outcomes in patients with subarachnoid hemorrhage by attenuating vasospasm [1].…”

Section: Cerebral Vasospasm Secondary To Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

“…It has been shown that MgSO 4 can decrease outcomes in patients with subarachnoid hemorrhage by attenuating vasospasm [1]. This is achieved by different mechanisms, including blockade of NMDA receptors, inhibition of excitatory amino acids, and antagonism of voltage-dependent Ca channels [60][61][62].…”

Section: Cerebral Vasospasm Secondary To Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

Basic considerations on magnesium in the management of neurocritical patients

et al. 2021

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Magnesium is an essential chemical element in human life. In the brain, it is physiologically responsible for a large number of processes involved in intracellular homeostasis, blood-brain barrier integrity, protein synthesis, neuronal proliferation, aging, and apoptosis. Considering that neurocritical care is a relatively new discipline in certain regions of the world and is an independent protective factor of neurological diseases in critical care, it is essential to disseminate basic concepts and utilities of tools that can positively impact the neurological disease burden. Magnesium and its use in neurocritical care are poorly understood. Therefore, this study aimed to review basic concepts regarding the physiology of magnesium in neurological dynamics, its role in the pathophysiology of neurological disorders, and the outcome of its use in the management of neurocritical illnesses.

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“…Dentre os vasodilatadores intra-arteriais, a milrinona (inibidor da fosfodiesterase-3) mostra ser a melhor opção, por apresentar um melhor desfecho tardio e melhora do vasoespamo angiográfico. No entanto, ainda não existem Case Report ensaios clínicos randomizados para confirmar sua eficácia 2,5,7,9,20,25,26,33,37,40,45 . A milrinona, quando usada intratecal ainda tem demonstrado redução na taxa de isquemia cerebral tardia, porém os estudos possuem pontos relevantes a se considerar, como "n" pequeno e ausência de grupos controle 6,35 .…”

Section: Introdução Relato De Casounclassified

Uso de Milrinona Endovenosa no Tratamento do Vasoespasmo Cerebral Pós-HSA Espontânea. Relato de Caso

Souza

Leal

Meneses

et al. 2020

jbnc

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Introdução: O vasoespasmo cerebral (VC) é a segunda maior causa de morbimortalidade em HSA aneurismática. Apesar da indicação do uso de nimodipino para sua prevenção ser bem estabelecida, ela não é totalmente eficaz. Logo, faz-se necessário o estudo de abordagens para o tratamento do VC. Nos últimos anos, a milrirona vem demonstrando eficácia para o tratamento do vasoespasmo seja em seu uso intra-arterial (IA) em dose única, em forma de bomba de infusão endovenosa ou intratecal por cateter lombar. Objetivo: Descrever um caso do uso da milrinona na abordagem terapêutica do VC. Métodos: Neste artigo relatamos um caso do uso combinado de milrinona IA (10 mL) e em bomba de infusão (0,375 mcg/kg/min) no tratamento do VC. Resultados: A paciente apresentou melhora clínica, e a angiografia por subtração digital mostrou melhora após dose IA e no controle após 4 dias de bomba de infusão. Conclusão: A associação de milrinona intra-arterial e endovenosa apresentou desfecho favorável clínico e radiológico.

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Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study

Cited by 16 publications

References 34 publications

The fragility index in randomised controlled trials of interventions for aneurysmal subarachnoid haemorrhage: a systematic review

The fragility index in randomised controlled trials of interventions for aneurysmal subarachnoid haemorrhage: a systematic review

Basic considerations on magnesium in the management of neurocritical patients

Uso de Milrinona Endovenosa no Tratamento do Vasoespasmo Cerebral Pós-HSA Espontânea. Relato de Caso

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