Intrathecal administration of nicardipine hydrochloride to prevent vasospasm in patients with subarachnoid hemorrhage.
OBJECTIVE
To evaluate the prophylactic effect of repeated intrathecal administration of nicardipine associated with hypertensive hypervolemic hemodilution therapy (triple H) and sodium correction, we analyzed a consecutive series of 177 patients with subarachnoid hemorrhage.


METHODS
All patients received aneurysmal clipping and placement of cisternal drainage within 48 hours of the onset. Intrathecal administration of 4 mg of nicardipine was performed every 12 h. Nicardipine concentrations in the cerebrospinal fluid (CSF) and blood before and after its administration were analyzed. Angiographic vasospasm (aVS), symptomatic VS (sVS), and clinical outcome 6 months after onset were also evaluated.


RESULTS
Nicardipine concentration in CSF on day 9 was 231.44 +/- 51.51 ng/ml (mean +/- SD), and that of blood was 21.05 +/- 15.57 ng/ml. Twenty patients (11.3%) showed aVS, and ten of those (5.7%) showed sVS (six were transient and four were permanent). Those with good outcome (assessed as good recovery and moderately disabled) 6 months after onset were 89.2% of the total. The number of patients requiring a shunt operation was 33 of 177 (18.6%), and 11 patients presented intracranial infection.


CONCLUSIONS
These results suggest that our strategy may well prevent VS. However, hydrocephalus and infection may be serious disadvantages that should be resolved.
Suzuki
M
M
Department of Neurosurgery, Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Japan. neurosur@po.cc.yamaguchi-u.ac.jp
Doi
M
M
Otawara
Y
Y
Ogasawara
K
K
Ogawa
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000032:analysis / Q000627:therapeutic use; D002533:Cerebral Angiography; D005260:Female; D006438:Hemodilution; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage* / Q000032:analysis / Q000627:therapeutic use; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*
D000959:Antihypertensive Agents; D009529:Nicardipine