Hyperdynamic Therapy for Cerebral Vasospasm

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The effects of hyperdynamic therapy on patients with cerebral vasospasm following subarachnoid hemorrhage (SAH), under normal blood pressure (BP) and normal blood volume conditions, are reported. Forty-four patients, who underwent surgery for aneurysms in acute stage, received hydroxyethyl starch (500 ml/day) postoperatively to prevent dehydration. Twenty-four of the 44 patients with prominent SAH on the computed tomographic (CT) scan, anticipating to develop cerebral ischemia due to vasospasm, were given dobutamine (DOB). The BP was maintained within the normal range, and the heart rate was kept below 130/min. In the 24 patients treated with DOB, cerebral blood flow (CBF) was measured repeatedly by the ^<133>Xe intravenous injection method. In 8 of these 24 patients, the cardiovascular function was monitored with Swan-Ganz (S-G) catheters. Twelve of the 44 patients (27%) developed delayed neurological deficits associated with cerebral vasospasm. The neurological deficits were reversed by the administration of DOB, at a dose of 8-25 (average 12.4) μg/kg/min. In 43 patients, the ischemic lesions associated with vasospasm did not appear on CT scan and the patients were of normal condition at discharge. However, one patient showed multiple low-density lesions on CT scan. This was because of the failure of hyperdynamic therapy due to pulmonary complications. No case of pulmonary edema or heart failure due to volume overload was noted. In the 24 patients with prominent SAH, CBF increased significantly by up to 20% following DOB administration, although the BP stayed in the normal range. In the 8 patients monitored with S-G catheter, the cardiac index increased markedly after treatment with DOB, but the pulmonary wedge pressure was remained below 10 mmHg. There were no significant changes in either the stroke volume index (SI) or the stroke-CBF (CBF/heart rate). Hyperdynamic therapy with DOB is effective for the postoperative management of cerebral vasospasm, and neither induced hypertension nor hypervolemia was necessary. DOB had positive inotropic effects, but did not decrease the SI or stroke-CBF, so that hyperdynamic therapy with DOB increased the CBF in patients with vasospasm, and caused no side effects.
日本脳神経外科学会の論文
1990-05-15

Hyperdynamic Therapy for Cerebral Vasospasm

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