The Effect of Intraventricular Administration of Nicardipine on Mean Cerebral Blood Flow Velocity Measured by Transcranial Doppler in the Treatment of Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Webb, Adam; Kolenda, Jennifer; Martin, Kathleen; Wright, Wendy L.; Samuels, Owen

doi:10.1007/s12028-009-9307-8

Cited by 42 publications

(29 citation statements)

References 37 publications

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“…Nicardipine can ameliorate the cerebral uptake of glucose and lactate, reduce cerebral oxygen consumption, increase cerebral OCI, and protect neurons 16,19 ; this results in an improvement in the physiological functions of the hippocampus, anterior cerebral white matter, basal ganglia, and pre-frontal cortex and consequently reducing the incidence of POCD. In contrast, nitroglycerin has been reported to produce no effect on cerebral blood flow [41][42][43] , and therefore, it cannot ameliorate the cerebral uptake of glucose and lactate and increase cerebral OCI. Thus, the incidence of POCD with nitroglycerine is higher than that with nicardipine.…”

Section: 5±324 ----------------------mentioning

confidence: 99%

Effects of vasodilator and esmolol-induced hemodynamic stability on early post-operative cognitive dysfunction in elderly patients: a randomized trial

Sun¹,

Yang²,

Sun³

et al. 2017

Afr H. Sci.

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Objective: To investigate the effect of continuous intravenous injection of nicardipine and/or nitroglycerin with or without esmolol on the occurrence of early post-operative cognitive dysfunction (POCD) in elderly patients. Methods: Elderly patients (n=340) who underwent radiofrequency ablation for atrial fibrillation were randomized into five groups: A, nicardipine; B nicardipine+esmolol; C, (nitroglycerin) group; D nitroglycerin+esmolol; E (control) groups. The hemodynamic parameters were recorded, and Mini Mental State Examination was used to assess cognitive function. Results: At 30 min and 60 minutes after anesthesia and at the conclusion of surgery, the rate pressure product value was significantly lower in Groups B (10621.1±321.7, 10544.2±321.8, and 10701.3±325.5, respectively) and D (10807.4±351.1, 10784.3±360.3, and 10771.7±345.7, respectively) than in Group E (13217.1±377.6, 13203.5±357.3, and 13119.2±379.5, respectively). The heart rate was significantly higher in Groups A (104.1±10.3, 104.9±11.1, and 103.9±11.8, respectively) and C (103.7±11.3, 105.5±10.5, and 107.7±11.7, respectively) than in Group E (89.3±12.0, 88.5±11.5, and 85.5±11.6, respectively). The incidence of POCD was significantly lower in Groups A and B than in Groups C, D, and E. Univariate regression analysis showed that regimens in Groups A, B, and E and doses of propofol and fentanyl were risk factors for POCD. Multivariate logistic regression analysis revealed significant associations between the incidence of POCD and interventions in Groups A and B. Conclusion: Maintenance of stable intraoperative hemodynamics using nicardipine and nitroglycerin or their combinations with esmolol, especially nicardipine with esmolol, reduced the incidence of POCD in the elderly with potential cardiovascular diseases. Afri Health Sci2016;16(4): 1056-1066

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Section: 5±324 ----------------------mentioning

confidence: 99%

Effects of vasodilator and esmolol-induced hemodynamic stability on early post-operative cognitive dysfunction in elderly patients: a randomized trial

Sun¹,

Yang²,

Sun³

et al. 2017

Afr H. Sci.

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“…The safety and efficacy of intrathecal nicardipine for the prevention and treatment of SAH-induced vasospasm has been clearly demonstrated in the clinical setting [58,119,133,134,135,136,137,138,139,140]. Shibuya et al [135] reported the effects of prophylactic serial administration of intrathecal nicardipine on vasospasm in 50 Fisher grade III SAH patients.…”

Section: Novel and Alternative Therapies For Sah-induced Cerebral Vasmentioning

confidence: 99%

“…Three-month outcome was good in all of the 5 cases. Intraventricular nicardipine has also been shown to be associated with a significant and sustained reduction in middle cerebral artery velocity as well as mean CBF velocity as measured by TCD when used in the treatment of cerebral vasospasm following aSAH [137,139]. …”

Section: Novel and Alternative Therapies For Sah-induced Cerebral Vasmentioning

confidence: 99%

Current Options for the Management of Aneurysmal Subarachnoid Hemorrhage-Induced Cerebral Vasospasm: A Comprehensive Review of the Literature

2013

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Objectives: Cerebral vasospasm is one of the leading causes of morbi-mortality following aneurysmal subarachnoid hemorrhage. The aim of this article is to discuss the current status of vasospasm therapy with emphasis on endovascular treatment. Methods: A comprehensive review of the literature obtained by a PubMed search. The most relevant articles related to medical, endovascular and alternative therapies were selected for discussion. Results: Current accepted medical options include the oral nimodipine and ‘triple-H' therapy (hypertension, hypervolemia and hemodilution). Nimodipine remains the only modality proven to reduce the incidence of infarction. Although widely used, ‘triple-H' therapy has not been demonstrated to significantly change overall outcome after cerebral vasospasm. Indeed, both induced hypervolemia and hemodilution may have deleterious effects, and more recent physiologic data favor normovolemia with induced hypertension or optimization of cardiac output. Endovascular options include percutaneous transluminal balloon angioplasty (PTA) and intra-arterial (IA) infusion of vasodilators. Multiple case reports and case series have been encountered in the literature using different drug regimens with diverse mechanisms of action. Compared with PTA, IA drug infusion has the advantages of distal penetration and a better safety profile. Its main disadvantages are the more frequent need for repeat treatments and its systemic hemodynamic repercussions. Alternative options using intraventricular/cisternal drug therapy and flow augmentation strategies have also shown possible benefits; however, their use is not yet as well established. Conclusion: Blood pressure or cardiac output optimization should be the mainstay of hyperdynamic therapy. Endovascular treatment appears to have a positive impact on neurological outcome compared with the natural history of the disease. The role of intraventricular therapy and flow augmentation strategies in association with medical and endovascular treatment may, in the future, play a growing role in the management of patients with severe refractory vasospasm.

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“…The literature comprises retrospective, mostly uncontrolled cohort studies. Investigators observed reduction in TCD velocities [61, 62] but no differences in 90-day outcomes between those treated with IT calcium channel blockers and historical controls [62]. …”

Section: Medical Therapiesmentioning

confidence: 99%

Rescue Therapy for Refractory Vasospasm after Subarachnoid Hemorrhage

Durrant

Hinson

2014

Curr Neurol Neurosci Rep

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Vasospasm and delayed cerebral ischemia remain to be the common causes of increased morbidity and mortality after aneurysmal subarachnoid hemorrhage. The majority of clinical vasospasm responds to hemodynamic augmentation and direct vascular intervention; however, a percentage of patients continue to have symptoms and neurological decline. Despite suboptimal evidence, clinicians have several options in treating refractory vasospasm in aneurysmal subarachnoid hemorrhage (aSAH), including cerebral blood flow enhancement, intra-arterial manipulations, and intra-arterial and intrathecal infusions. This review addresses standard treatments as well as emerging novel therapies aimed at improving cerebral perfusion and ameliorating the neurologic deterioration associated with vasospasm and delayed cerebral ischemia.

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The Effect of Intraventricular Administration of Nicardipine on Mean Cerebral Blood Flow Velocity Measured by Transcranial Doppler in the Treatment of Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Cited by 42 publications

References 37 publications

Effects of vasodilator and esmolol-induced hemodynamic stability on early post-operative cognitive dysfunction in elderly patients: a randomized trial

Effects of vasodilator and esmolol-induced hemodynamic stability on early post-operative cognitive dysfunction in elderly patients: a randomized trial

Current Options for the Management of Aneurysmal Subarachnoid Hemorrhage-Induced Cerebral Vasospasm: A Comprehensive Review of the Literature

Rescue Therapy for Refractory Vasospasm after Subarachnoid Hemorrhage

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