An Observational Study on the Effect of Nimodipine on Cerebral Blood Flow Velocity and Oxygenation in Patients with Subarachnoid Haemorrhage

Abstract

In patients with subarachnoid haemorrhage (SAH), nimodipine is administered to prevent for cerebral vasospasm. In this prospective observational study, we examined the effect of nimodipine on cerebral blood flow velocity (BFV) (transcranial Doppler, TCD) and regional oxygen saturation (rSO 2 ) (near-infrared spectroscopy, NIRS) as well as its systemic haemodynamic effects. Methods After ethics approval, we enrolled 18 adult patients (11 females) with SAH after aneurysm rupture. After treatment of the bleeding source, patients underwent extended haemodynamic monitoring by transpulmonary thermodilution (PiCCOTM, Pulsion, Maquet Getinge Group, Feldkirchen, Germany). Measurements of systemic haemodynamics as well as cerebral oxygenation and blood flow velocity were performed 30 minutes before and after the enteral administration of nimodipine (60 mg). Data was compared by paired t-test. A p<0.05 was considered as statistically significant. Data are expressed as mean ± SD. ResultsPatients' mean age was 59 ± 11 years. Enteral nimodipinincrease in heart rate (75 vs. 79/min, p<0.05) and cardiac index (3.27 vs. 3.58 l/min/m 2 , p<0.05). While noe administration was associated with a decrease in mean arterial pressure (93 vs. 88 mmHg, p<0.05), an radrenaline dose and BFV did not change significantly, NIRS revealed a reduction in cerebral oxygenation, but rSO 2 values remained within a healthy range in all patients (right 71 vs. 69 %, p<0.05; left 74 vs. 72 %, p<0.05). ConclusionsIn patients with SAH, enteral nimodipine led to inconclusive changes in systemic haemodynamics. Although cerebral oxygenation as assessed by NIRS decreased after nimodipine administration, BFV remained stable.

Cerebral Vasospasm After Traumatic Subarachnoid Hemorrhage and Its Risk Factor: Combined Periodic Follow Up of Transcranial Doppler and CT Angiography

“…Patients diagnosed with vasospasm were initially given oral nimodipine 9) . In cases where severe vasospasm was observed on CTA, intra-arterial chemical angioplasty was performed on five patients (Fig.…”