急性期脳動脈瘤手術におけるisoproterenol, aminophyllineの使用経験

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Results of aneurysm operations are unsatisfactory when they are performed within one week after the subarachnoid hemorrhage. The major cause of the poor results is vasospasms in the postoperative period. The authors propose prophylactic administration of isoproterenol and aminophylline in the postoperative period before actual signs of vasospasms appear. The treatment lasts two weeks after a subarachnoid hemorrhage. In eighteen cases in which this scheduled treatment was completed, seventeen showed full recovery and one had permanent hemiparesis. In the course of treatment, however, various side effects were encountered such as polyuria, convulsive seizure, abnormal psychiatric condition, nausea, vomiting, hiccup and hypotension. In three cases, hemiparesis and deteriorated sensorium level developed during interruption of infusion of the drugs. Angiography revealedvasospasms and a prolonged circulation time. These signs disappeared shortly after re-starting the regimen. In the other two cases, signs of vasospasms appeared in the course of treatment. These cases were handled by increasing the circulating volume using 5% albumin fluicl and i.v. hydrocortisone. They showed excellent recovery. Postoperative angiography showed vasospasms in ten cascrs out of eighteen without signs of vasospasms. The authors concluded that prophylactic administration of these drugs is indispensable when operations are performed on intracranial ruptured aneurysms in the acute stage, despite of the numerous side effects and large amount of labor required for precise observations and for maintaining a constant blood level of drugs for two weeks.
日本脳神経外科学会の論文
1980-10-15

急性期脳動脈瘤手術におけるisoproterenol, aminophyllineの使用経験

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