title: Use of intrathecal nicardipine for aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm.
abstract: BACKGROUND
  Cerebral vasospasm leading to delayed ischemia is a common and serious complication of aneurysmal subarachnoid hemorrhage that often results in increased morbidity and mortality. Treatments for cerebral vasospasm, including triple-H therapy (therapeutic hypervolemia, hypertension, and hemodilution), nimodipine, balloon angioplasty, and intra-arterial vasodilators have limitations in their efficacy and safety profiles. Nicardipine, a calcium channel blocker, is available for intravenous administration for blood pressure reduction. A recent study reported its efficacy in the treatment of cerebral vasospasm when given intrathecally (IT). We present our experiences with IT nicardipine for treatment of cerebral vasospasm.
  
  
  METHODS
  IT nicardipine was administered to six patients with aneurysmal subarachnoid hemorrhage after prophylactic and aggressive therapeutic management for vasospasm failed.
  
  
  RESULTS
  In these patients, IT nicardipine treatment was followed within 8 hours by a 43.1 +/- 31.0 cm/s decrease in middle cerebral arterial flow velocity, as measured by transcranial Doppler ultrasound.
  
  
  CONCLUSIONS
  Based on these positive results, we believe that larger scale studies evaluating the safety and efficacy of IT nicardipine for the management of cerebral vasospasm are warranted.
authors.affiliation: Neuroscience Critical Care Unit, Via Christi Regional Medical Center, University of Kansas School of Medicine, Wichita, KS 67214, USA. aehtisham@kumc.edu
authors.forename: As'ad
authors.initials: A
authors.lastname: Ehtisham
authors.forename: Scott
authors.initials: S
authors.lastname: Taylor
authors.forename: Linda
authors.initials: L
authors.lastname: Bayless
authors.forename: Owen B
authors.initials: OB
authors.lastname: Samuels
authors.forename: Michael W
authors.initials: MW
authors.lastname: Klein
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Janzen
mesh_terms: D000328:Adult; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage / Q000627:therapeutic use*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology
chemical_list: D002121:Calcium Channel Blockers; D009529:Nicardipine