Impact of Early Versus Late Intravenous Followed by Oral Nimodipine Treatment on the Occurrence of Delayed Cerebral Ischemia Among Patients With Aneurysm Subarachnoid Hemorrhage

Samseethong, Tipada; Suansanae, Thanarat; Veerasarn, Kullapat; Liengudom, Anusak; Suthisisang, Chuthamanee

doi:10.1177/1060028018778751

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…The intravenous administration of nimodipine therefore represents an alternative and has been investigated in several studies in the past due to its relevance ( 26 – 28 ). The aim of this analysis was to systematically evaluate our clinical observations of whether neurological and intensive care parameters change immediately due to the change from i.v.…”

Section: Introductionmentioning

confidence: 99%

Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage

Göttsche¹,

Schweingruber²,

Groth³

et al. 2021

Front. Neurol.

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Objective: Several guidelines recommend oral administration of nimodipine as vasospasm prophylaxis after aneurysmal subarachnoid hemorrhage (SAH). However, in clinical practice, the drug is administered orally and intravenously (i.v.), depending on clinical conditions and local treatment regimens. We have therefore investigated the safety and clinical effects of switching from i.v. to oral nimodipine therapy.Methods: Patients with aneurysmal SAH between January 2014 and April 2018 and initial i.v. nimodipine therapy, which was subsequently switched to oral administration, were included in this retrospective study. Transcranial Doppler sonography (TCD) of the vessels of the anterior circulation was performed daily. The occurrence of vasospasm and infarction during the overall course of the treatment was recorded. Statistical level of significance was set to p < 0.05.Results: A total of 133 patients (mean age 55.8 years, 65% female) initially received nimodipine i.v. after aneurysmal SAH, which was subsequently switched to oral administration after a mean of 12 days. There were no significant increases in mean flow velocities on TCD after the switch from i.v. to oral nimodipine administration regarding the anterior cerebral artery. For the middle cerebral artery, an increase from 62.36 to 71.78 cm/sec could only be detected in the subgroup of patients with infarction. There was no clustering of complicating events such as new-onset vasospasm or infarction during or after the switch.Conclusions: Our results do not point to any safety concerns when switching nimodipine from initial i.v. to oral administration. Switching was neither associated with clinically relevant increases in TCD velocities nor other relevant adverse events.

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Section: Introductionmentioning

confidence: 99%

Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage

Göttsche¹,

Schweingruber²,

Groth³

et al. 2021

Front. Neurol.

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“…7,8 Karena itu, perawatan dini dengan IV nimodipine mungkin berpotensi mengurangi kejadian vasospasme setelah SAH dan mengurangi kejadian Delayed Cerebral Iskemik. 9,10 Dalam kasus ini, pemberian nimodipin oral berhasil mencegah terjadinya vasospasme serebral ditunjukkan dengan tanda tidak ada perburukan pasien dan tidak didapatkan adanya defisit neurologis pada saat perawatan di ruang intensif.…”

Section: Kasusunclassified

Penggunaan Calcium Channel Blocker pada Tatalaksana Anestesi Clipping Aneurisma Otak

Rindiati

Sasongko

Harahap

2019

JNI

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Perdarahan subarachnoid dapat diartikan sebagai proses pecahnya pembuluh darah di ruang yang berada dibawah arakhnoid (subarachnoid). Prevalensi terjadinya perdarahan subaraknoid dapat mencapai hingga 33.000 orang per tahun di Amerika Serikat. Penyebab paling sering perdarahan subarachnoid adalah ruptur aneurisma salah satu arteri di dasar otak dan adanya malformasi arteriovena (MAV). Pada umumnya aneurisma terjadi pada sekitar 5% dari populasi orang dewasa, terutama pada wanita. Penanganan pada aneurisma pembuluh darah otak salah satunya dengan clipping aneurisma. Tindakan tersebut beresiko terjadi vasospasme serebral. Nimodipine adalah suatu calcium chanel blocker yang penting dalam pengelolaan operasi aneurisma karena mempunyai efek vasodilatasi pembuluh darah serebral dan termasuk dalam bagian dari manajemen vasospasme serebral. Pada laporan ini, dilaporkan dua kasus tindaan clipping aneurisma. Pasien pertama adalah wanita usia 69 tahun, berat badan 60 kg dengan diagnosa SAH hari ke 18 yang mengalami defisit neurologi berupa hemiparese dextra dan afasia motorik. Pasien kedua adalah wanita usia 57 tahun berat badan 60 kg dengan diagnosa SAH hari ke 20 dan mengalami defisit neurologi hemiparese kanan dan afasia sensorik. Pada kedua pasien dilakukan tindakan pembedahan kraniotomi clipping aneurisma. Kedua pasien memiliki hasil akhir yang baik. Akan tetapi, ada perbedaan lama perawatan antara pasien yang menjalani terapi awal nimodipine dan yang tidak menerima terapi tersebut.Administration of Calcium Channel Blocker in Anaesthesia Management of Cerebral Aneurysm ClippingAbstractSubarachnoid hemorrhage can be interpreted as the process of rupture of blood vessels in the space under the arachnoid (subarachnoid). The prevalence of subarachnoid hemorrhage can reach up to 33,000 people per year in the United States. The most common causes of subarachnoid bleeding are ruptured aneurysm in one of the arteries at the base of the brain and the presence of arteriovenous malformations (MAV). In general, aneurysms occur in about 5% of the adult population, especially in women.Therapy in cerebral vascular aneurysms, one of which is clipping aneurysms. These actions are at risk of cerebral vasospasm. Nimodipine is a calcium channel blocker which is important in the management of aneurysm surgery because it has a vasodilating effect on cerebral vessels and is included in the management of cerebral vasospasm. In this report, two cases of clipping aneurysm are reported. The first patient was a woman aged 69 years, body weight 60 kg with a diagnosis of SAH day 18 who had a neurological deficit in the form of hemiparese dextra and motor aphasia. The second patient was a 57-year-old woman weighing 60 kg with a diagnosis of SAH day 20 and had a neurological deficit in the form of right hemiparese and sensory aphasia. In both patients, clipping aneurysm was performed by craniotomy surgery. Both patients had good results. However, there is a difference in the length of stay between patients who underwent initial nimodipine therapy and who did not receive it.

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“…A plethora of medical treatment options to attenuate vasospasm, such as statins, corticosteroids, clazosentan, milrinone, magnesium sulfate, fasudil hydrochloride, cilostazol and edaravone, has been tested in both, experimental and clinical settings; however, with exemption of one single agent, the calcium channel antagonist nimodipine, no systemic medical therapy has shown a robust and reproducible effect on functional outcome in these patients [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Therefore, in most centers, enteral administration of nimodipine is part of the standard treatment protocol in order to prevent vasospasm; however, different routes of administration including parenteral intravenous administration, intrathecal administration via external ventricular drainage and intracisternal administration via stereotactically placed catheters have been used and tested; yet, these alternative methods of administration remain to be of experimental character [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Furthermore, nimodipine has been administered intraarterially as a measure of local vasodilative rescue therapy in cases of symptomatic delayed cerebral vasospasm [ 17 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

The Local Intraarterial Administration of Nimodipine Might Positively Affect Clinical Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage and Delayed Cerebral Ischemia

Walter

Grutza

Möhlenbruch

et al. 2022

JCM

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The effect of the intraarterial administration of nimodipine as a rescue measure to treat delayed vasospasm after aSAH remains understudied; therefore, we evaluated its effect on short- and long-term functional and neuropsychological outcomes after aSAH. In this prospective observational study, a total of 107 consecutive patients treated for aSAH of WFNS grades I–V were recruited. At follow-up visits 3-, 12- and 24-months after the hemorrhage, functional outcome was assessed using the Extended Glasgow Outcome (GOSE) and modified Rankin (mRS) scales, while neurocognitive function was evaluated using the screening module of the Neuropsychological Assessment Battery (NAB-S). The outcome of patients, who had received rescue therapy according to the local standard treatment protocol (interventional group, n = 37), and those, who had been treated conservatively (conservative group, n = 70), were compared. Even though significantly more patients in the interventional treatment group suffered from high-grade aSAH (WFNS Grades IV and V, 54.1% vs. 31.4%, p = 0.04) and required continuous drainage of cerebrospinal fluid at discharge (67.7% vs. 37.7%, p = 0.02) compared to the control group, significant differences in functional outcome were present only at discharge and three months after the bleeding (GOSE > 4 in 8.1% vs. 41.4% and 28.6% vs. 72.7%, p < 0.001 and p = 0.01 for the interventional and control group, respectively). Thereafter, group differences were no longer significant. While significantly more patients in the intervention group had severe neuropsychological deficits (76.3% vs. 36.0% and 66.7% vs. 29.2%, p = 0.04 and 0.05, respectively) and were unable to work (5.9% vs. 38.1%, p = 0.03 at twelve months) at three and twelve months after the hemorrhage, no significant differences between the two groups could be detected at long-term follow-up. The presence of moderate neuropsychological impairments did not significantly differ between the groups at any timepoint. In conclusion, despite initially being significantly more impaired, patients treated with intraarterial administration of nimodipine reached the same functional and neuropsychological outcomes at medium- and long-term follow-up as conservatively treated patients suggesting a potential beneficial effect of intraarterial nimodipine treatment for delayed vasospasm after aSAH.

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Impact of Early Versus Late Intravenous Followed by Oral Nimodipine Treatment on the Occurrence of Delayed Cerebral Ischemia Among Patients With Aneurysm Subarachnoid Hemorrhage

Abstract: Receiving IV nimodipine 3 to 7 days following oral therapy after bleeding can be the alternative regimen in patients who did not start nimodipine within 96 hours.

Cited by 11 publications

References 31 publications

Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage

Safety and Clinical Effects of Switching From Intravenous to Oral Nimodipine Administration in Aneurysmal Subarachnoid Hemorrhage

Penggunaan Calcium Channel Blocker pada Tatalaksana Anestesi Clipping Aneurisma Otak

The Local Intraarterial Administration of Nimodipine Might Positively Affect Clinical Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage and Delayed Cerebral Ischemia

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