title: Anesthetic considerations of selective intra-arterial nicardipine injection for intracranial vasospasm: a case series.
abstract: Cerebral vasospasm after subarachnoid hemorrhage can decrease cerebral blood flow with the potential for stroke. Induction of Triple-H therapy (hypertension, hypervolemia, and hemodilution) is an accepted medical therapy to decrease the delayed cerebral ischemia related to vasospasm. Recently selective intra-arterial injection of nicardipine during angiography has also been proposed as a therapeutic modality for the management of distal vasospasm not amenable to balloon angioplasty. We are reporting the hemodynamic changes in 11 patients who underwent this procedure. A retrospective chart review of 15 procedures in 11 patients showed a significant change in blood pressure after the injection of nicardipine. Blood pressure changes were not different between sexes, but increase in heart rate was higher for females. A significantly higher drop in systolic blood pressure but not for diastolic blood pressure or mean arterial pressure after the injection was seen in patients who were not intubated in the intensive care unit before the procedure. Selective intra-arterial injection of nicardipine during angiography can cause significant hemodynamic instability and requires supportive management by the anesthesiologist.
authors.affiliation: Departments of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. avitsir@ccf.org
authors.forename: Rafi
authors.initials: R
authors.lastname: Avitsian
authors.forename: David
authors.initials: D
authors.lastname: Fiorella
authors.forename: Marcos M
authors.initials: MM
authors.lastname: Soliman
authors.forename: Edward
authors.initials: E
authors.lastname: Mascha
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
chemical_list: D002121:Calcium Channel Blockers; D009529:Nicardipine