title: Use of GABAergic sedatives after subarachnoid hemorrhage is associated with worse outcome-preliminary findings.
abstract: OBJECTIVE
  Recent experimental evidence identified GABAergic sedation as a possible cause for deprived neuroregeneration and poor outcome after acute brain injury. Patients with aneurysmal subarachnoid hemorrhage are often sedated, and GABAergic sedation, such as midazolam and propofol, is commonly used.
  
  
  METHODS
  Retrospective cohort study based on a prospectively established database.
  
  
  METHODS
  Single-center neurointensive care unit.
  
  
  METHODS
  Twenty-nine patients after subarachnoid hemorrhage.
  
  
  METHODS
  Noninterventional study.
  
  
  METHODS
  The relationship between mean GABAergic sedative dose during the acute phase and outcome after 6 months according to the Glasgow Outcome Scale, and initial Glasgow Coma Scale was investigated.
  
  
  RESULTS
  Use of GABAergic sedatives was negatively correlated with Glasgow Outcome Scale (r2=0.267; P=.008). Administration of sedatives was independent of the initial Glasgow Coma Scale. GABAergic sedatives flunitrazepam, midazolam, and propofol were used differently during the first 10 days after ictus.
  
  
  CONCLUSIONS
  Administration of GABAergic sedation was associated with an unfavorable outcome after 6 months. To avoid bias (mainly through the indication to use sedation), additional experimental and comparative clinical investigation of, for example, non-GABAergic sedation, and clinical protocols of no sedation is necessary.
authors.affiliation: Department of Neurosurgery, University of Heidelberg, 69120 Heidelberg, Germany. Electronic address: daniel.hertle@med.uni-heidelberg.de.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Hertle
authors.affiliation: Department of Neurosurgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Beynon
authors.affiliation: Department of Neurosurgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Jan O
authors.initials: JO
authors.lastname: Neumann
authors.affiliation: Department of Neurosurgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Edgar
authors.initials: E
authors.lastname: Santos
authors.affiliation: Department of Neurosurgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Renan
authors.initials: R
authors.lastname: Sánchez-Porras
authors.affiliation: Department of Neurosurgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Unterberg
authors.affiliation: Department of Neurosurgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Sakowitz
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000502:physiology*; D016292:Procedural Sedation / Q000379:methods; D005260:Female; D005445:Flunitrazepam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018757:GABA Modulators / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015600:Glasgow Coma Scale; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012038:Regeneration / Q000187:drug effects*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*
chemical_list: D018757:GABA Modulators; D006993:Hypnotics and Sedatives; D005445:Flunitrazepam; D008874:Midazolam; D015742:Propofol
keywords: Midazolam; Outcome; Propofol; SAH; Sedation