title: Acute effects of intraventricular nicardipine on cerebral hemodynamics: A preliminary finding.
abstract: OBJECTIVE
  Intraventricular nicardipine (IVTN) is a treatment option for severe vasospasm in patients with subarachnoid hemorrhage (SAH). However, its acute effects on cerebral hemodynamics have not been studied in detail.
  
  
  METHODS
  Between June 2008 and December 2010, IVTN was administered (mainly 4mg every 8h) to 11 SAH patients (54 doses) with multimodality monitoring for refractory vasospasm. Retrospective analyses on physiological parameters were made from baseline and up to 6h after IVTN injection. Statistical analysis was performed with a mixed-effects model.
  
  
  RESULTS
  Mean intracranial pressure (ICP) increased slightly, reaching its peak at 20min after IVTN injection (2.5±0.9mmHg (mean±standard error), P<0.01), and decreased gradually thereafter over the next hour. Mean cerebral perfusion pressure transiently decreased 20-30min after injection (3.7±1.8mmHg, P<0.05). Mean arterial pressure, partial pressure of brain oxygen tension (PbtO2), cerebral blood flow (CBF), autoregulation indices did not change significantly. Lactate/pyruvate ratio and glucose remained stable. One patient underwent transcranial Doppler ultrasonography monitoring while on IVTN, which showed a transient increase in mean flow velocity with concomitant decrease in Pulsatility index, suggesting vasodilation in the distal resistance vessels.
  
  
  CONCLUSIONS
  The vasodilatory effect of IVTN transiently increased ICP, but did not significantly affect PbtO2, CBF or oxidative glucose metabolism in the immediate phase after injection.
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Sang-Bae
authors.initials: SB
authors.lastname: Ko
authors.affiliation: Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute, Memorial Hermann of Texas Medical Center, Houston, TX, USA.
authors.forename: H Alex
authors.initials: HA
authors.lastname: Choi
authors.affiliation: Clinical Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.affiliation: Neuro Intensive Care Unit, Brain Institute Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Kurtz
authors.affiliation: Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.affiliation: Section of Neurocritical Care, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.affiliation: Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Neurosurgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.affiliation: Department of Neurosurgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.affiliation: Departments of Neurology and Neurosurgery, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.affiliation: Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute, Memorial Hermann of Texas Medical Center, Houston, TX, USA. Electronic address: Kiwon.Lee@uth.tmc.edu.
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply / Q000187:drug effects* / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D057967:Infusions, Intraventricular; D007427:Intracranial Pressure / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy / Q000503:physiopathology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D009529:Nicardipine
keywords: Autoregulation index; Brain oxygen tension; Cerebral blood flow; Intraventricular nicardipine; Multimodality monitoring; Subarachnoid hemorrhage