title: Milrinone reduces cerebral vasospasm after subarachnoid hemorrhage of WFNS grade IV or V.
abstract: The preventative effect of cisternal irrigation with milrinone against vasospasm was evaluated in 12 patients with subarachnoid hemorrhage (SAH) of World Federation of Neurosurgical Societies grade IV or V treated between September 1999 and September 2000. All aneurysms were clipped or embolized within 72 hours of the onset of SAH. Inlet and outlet tubes were placed in either the supratentorial cisternal space, lateral ventricle, or spinal subarachnoid space. Lactated Ringer solution containing urokinase (120 IU/ml), ascorbic acid (3.5 mg/ml), and milrinone (3.6 microg/ml) was continuously infused at 30 ml/hr for as long as 2 weeks. Angiographical vasospasm was detected in only two of the 11 patients who received milrinone irrigation and underwent postoperative angiography. Vasospasm may have resulted from irrigation obstruction associated with pneumocephalus in one patient and clot in the sylvian fissure in the other patient. The outcome of the milrinone irrigation therapy was significantly better than that of the conventional therapy. This study suggests that cisternal irrigation with milrinone is safe and effective, and reduces the occurrence of vasospasm in patients with poor grade aneurysmal SAH.
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama. yarakawa@sb3.so-net.ne.jp
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Arakawa
authors.forename: Ken-ichiro
authors.initials: K
authors.lastname: Kikuta
authors.forename: Masato
authors.initials: M
authors.lastname: Hojo
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Goto
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nozaki
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hashimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002946:Cisterna Magna / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage / Q000627:therapeutic use*; D011859:Radiography; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D007507:Therapeutic Irrigation; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*
chemical_list: D014665:Vasodilator Agents; D020105:Milrinone