Investigating the relationship between high-dose norepinephrine administration and the incidence of delayed cerebral infarction in patients with aneurysmal subarachnoid hemorrhage: A single-center retrospective evaluation

Cattaneo, Andrea; Wipplinger, Christoph; Geske, Caroline; Semmler, Florian; Wipplinger, Tamara M; Griessenauer, Christoph J.; Weiland, Judith; Beez, Alexandra; Ernestus, Ralf‐Ingo; Westermaier, Thomas; Kunze, Ekkehard; Stetter, Christian

doi:10.1371/journal.pone.0283180

Cited by 5 publications

(2 citation statements)

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“…Earlier studies considered vasospasm as the main risk factor for DCI, but later studies described significant rates of DCI independent of vasospasm [ 21 , 39 ]. In our study, more than half of the patients with vasospasm did not develop DCI.…”

Section: Discussionmentioning

confidence: 99%

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Serum concentration–guided intravenous magnesium sulfate administration for neuroprotection in patients with aneurysmal subarachnoid hemorrhage: a retrospective evaluation of a 12-year single-center experience

Wipplinger,

Cattaneo,

Wipplinger

et al. 2023

Neurosurg Rev

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Delayed cerebral infarction (DCI) is a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). The benefits of magnesium sulfate as an alternative treatment are controversial, and most previous studies examined its benefits only as adjunctive treatment to traditional nimodipine. We retrospectively analyzed aSAH patients records with magnesium sulfate between 2010 and 2021. We aimed for a serum magnesium concentration of 2–2.5 mmol/l between post-hemorrhage days 3 and 12. The patients were separated in three groups based on average serum magnesium concentration (magnesium >2 mmol/l, reduced magnesium 1.1–1.9 mmol/l, and no magnesium). Additionally, we assessed delayed cerebral infarction (DCI) and clinical outcome at follow-up, using the modified Rankin Scale (mRS), categorized in favorable (0–3) and unfavorable outcome (4–5). In this analysis, 548 patients were included. Hereof, radiological evidence of DCI could be found in 23.0% (n = 126) of patients. DCI rates were lower if patients’ average serum magnesium was higher than 2 mmol/l (magnesium 18.8%, n = 85; reduced magnesium 38.3%, n = 23; no magnesium 51.4%, n = 18; p < 0.001). Also, at the last follow-up, patients in the group with a higher serum magnesium concentration had better outcome (favorable outcome: magnesium 64.7%, n = 293; reduced magnesium 50.0%, n = 30; no magnesium 34.3%, n = 12; p < 0.001). This 12-year study reveals the value of serum concentration-guided magnesium administration in aSAH patients. Our findings demonstrate the safety and efficacy when titrated to a serum concentration of 2–2.5 mmol/l. We observed higher rates of delayed cerebral infarction and unfavorable outcomes in patients with serum concentrations below 2 mmol/l.

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Section: Discussionmentioning

confidence: 99%

“…For a more detailed description of our institutional management of aSAH patients, we refer to our previous works [ 14 , 18 , 21 ].…”

Section: Methodsmentioning

confidence: 99%