doi: 10.1161/hs0202.103410
(Stroke. 2002;33:486.)
© 2002 American Heart Association, Inc.
Original Contributions |
Safety of Intraventricular Sodium Nitroprusside and Thiosulfate for the Treatment of Cerebral Vasospasm in the Intensive Care Unit Setting
From the Division of Neurosurgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque.
Correspondence to Jeffrey E. Thomas, MD, Division of Neurosurgery, Department of Surgery, University of New Mexico Health Sciences Center, 915 Camino de Salud, ACC 2nd Floor, Albuquerque, NM 87131. E-mail tokyojet14{at}netscape.net, jethomas@salud.unm.edu
Background and Purpose— We have recently reported the safety of intraventricular sodium nitroprusside for the treatment of cerebral ischemia from vasospasm. Treatments have been accompanied previously by cerebral angiography to gauge treatment effect on established vasospasm. We presently report the safe coadministration of intraventricular sodium nitroprusside and thiosulfate in 10 patients with secured ruptured cerebral aneurysms in the intensive care unit, without the use of cerebral angiography for vasospasm treatment.
Methods— Patients were considered eligible for treatment on the basis of subarachnoid hemorrhage grade or manifestation of cerebral vasospasm by either transcranial Doppler ultrasonography (TCD) or neurological examination criteria. The route of administration was intraventricular, by way of ventriculostomy. Two separate protocols differing in dosage frequency were used, depending on the presence or absence of a new neurological deficit. Response to treatment was measured by TCD and neurological criteria.
Results— Good outcome was observed in 7 of 8 vasospasm patients presenting with clinical subarachnoid hemorrhage grade 
3. Four patients demonstrated reversal of well-defined neurological deficits (hemiparesis, paraparesis) in the setting of treatment. Seven patients demonstrated a decrease in TCD velocities within 1 hour of treatment. Two patients died: 1 from intractable vasospasm despite maximal medical management and angioplasty and 1 from pulmonary causes. One episode of hypotension occurred in the setting of a high dose of medication. This responded promptly to medical management. Prolonged intracranial hypertension did not occur; modest elevations of both intracranial pressure and mean arterial blood pressure were observed when nausea and vomiting were associated with treatment, which occurred commonly in awake subjects.
Conclusions— Intraventricular sodium nitroprusside with thiosulfate may be safely administered in the intensive care unit setting without the requirement of cerebral angiography to guide the effects of therapy.
Key Words: cerebral ischemia • injections, intraventricular • nitroprusside • thiosulfates • vasospasm
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