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Hypotensive effect of nimodipine during treatment for aneurysmal subarachnoid haemorrhage

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Summary

To determine the incidence of induced systemic hypotension in patients after aneurysmal subarachnoid haemorrhage (SAH) and nimodipine treatment 87 consecutive cases were reviewed.

The patients were managed according to the same Nimodipine treatment protocol. After confirmation of SAH the nimodipine treatment was started as a continuous intravenous perfusion at a dosage of 0.5 mg/h and gradually increased every 6 hours if haemodynamically tolerated until the maintenance dose of 2 mg/h was reached. Median systemic pressure was continuously measured and tolerated until a lowest limit of 75 mmHg. In 31 patients (36%) hypotension with values below 75 mmHg during at least 30 minutes was noted and needed Nimodipine reduction. Intravenous Nimodipine administration was responsible for hypotension in 26 cases as compared to 5 cases due to oral administration. 38% of all patients required support by vaso-active agents (Dopamine or Noradrenaline).

There was no statistically significant difference of incidence of delayed ischaemic deterioration comparing the Nimodipine-reduction group with the normal dose group.

This study demonstrates that a considerable risk exists of Nimodipine induced hypotension in intravenous administration despite gradually increasing the doses. Correction of hypotension through further induced hypervolaemia accompanied by vasoactive agents can lead to critical haemodynamic situations. We therefore recommend oral Nimodipine administration.

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References

  1. Adams HP (1990) Calcium antagonists in the management of patients with aneurysmal subarachnoid hemorrhage: a review. Angiology 41: 1010–1016

    Google Scholar 

  2. Ades PE, Fabre M, Aesch Bet al (1989) La nimodipine amélioret-elle la tolérance aux complications périopératoires de la rupture anévrismale? Résultats d'un traitement systématique. Agressologic 30: 431–436

    Google Scholar 

  3. Auer LM (1991) Unfavourable outcome following early surgical repair of ruptured cerebral aneurysms — a critical review of 238 patients. Surg Neurol 35: 152–158

    Google Scholar 

  4. Bailes JE, Spetzler RF, Hadley RNet al (1990) Management, morbidity and mortality of poor-grade aneurysms patients. J Neurosurg 72: 559–566

    Google Scholar 

  5. Bidzinski J, Marchel A, Pastuszko M (1990) Acute surgery in intracranial aneurysms; experience with 100 cases. Acta Neurochir (Wien) 103: 1–4

    Google Scholar 

  6. Dorsch NW, Besser M, Brazenor GAet al (1989) Timing of surgery for cerebral aneurysms: a plea for early referral. Med J Aust 150: 183: 187–188

    Google Scholar 

  7. Frerebeau Ph, Janny P, Taquoi Get al (1988) Traitement curatif du vasospasme des hémorragies méningées d'origine anévrismale par la Nimodipine intraveineuse: etude coopérative multicentrique. Neurochirurgie 34: 383–388

    Google Scholar 

  8. Gilsbach JM, Harders AG, Eggert HRet al (1988) Early aneurysm surgery: a 7-year clinical practice report. Acta Neurochir (Wien) 90: 91–102

    Google Scholar 

  9. Gilsbach JM, Harders AG (1989) Morbidity and mortality after early aneurysm surgery — a prospective study in Nimodipine prevention. Acta Neurochir (Wien) 96: 1–7

    Google Scholar 

  10. Gilsbach JM, Reulen HJ, Ljunggren Bet al (1990) Earlyaneurysm surgery and preventive therapy with intravenously administered Nimodipine: a multicenter, double blind, dose-comparison study. Neurosurgery 26: 458–464

    Google Scholar 

  11. Gutknecht JL, Irthum B, Cavaroc Get al (1990) Bilan du traitement des hémorragies méningées anévrismales par antifibrinolytique, inhibiteur calcique et maintien d'une volémie efficace. Agressologie 31: 340–343

    Google Scholar 

  12. Han DH (1993) Effect of Nimodipine treatment on outcome in surgical cases of aneurysmal SAH. Presented at the annual meeting of the american association of neurological surgeons, Boston, Massachusetts, April 24–29

  13. Hillman J, v Essen C, Leszniewski W (1988) Results of treatment for cerebral saccular aneurysm in a small neurosurgical unit-evaluation of early operation and Nimodipine treatment. Acta Neurochir (Wien) 94: 28–31

    Google Scholar 

  14. Hund E, Aschoff A, Tronnier V (1990) Nimodipine: evidence for clinically significant gastrointestinal side effects. Acta Neurochir (Wien) 102: 73–75

    Google Scholar 

  15. Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20

    Google Scholar 

  16. Hunt WE, Kassell N, Pertuiset B, Sano K, Teasdale G, de Villier JC, Drake CG (1988) Report of the World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg 68: 985–986

    Google Scholar 

  17. Juvela S, Kaste M, Hillbom M (1989) The effects of early surgery and shorter bedrest on the outcome in patients with subarachnoid haemorrhage. J Neurosurg Psychiatry 52: 776–777

    Google Scholar 

  18. Juvela S, Kaste M, Hillbom M (1990) Effect of Nimodipine on platelet function in patients with subarachnoid hemorrhage. Stroke 21: 1283–1288

    Google Scholar 

  19. Kassell NF, Torner JC, Haley EC Jret al (1990) The international cooperative study on the timing of aneurysm surgery. Part 1: overall management results. J Neurosurg 73: 18–36

    Google Scholar 

  20. Kassell NF, Torner JC, Jane JAet al (1990) The international cooperative study on the timing of aneurysm surgery. Part 2: surgical results. J Neurosurg 73: 37–47

    Google Scholar 

  21. Kostron H, Twerdy K, Grunert V (1988) The calcium entry blocker Nimodipine improves the quality of life of patients operated on for cerebral aneurysms. Neurochirurgia 31: 150–153

    Google Scholar 

  22. Ljunggren B, Fodstad H, Romner B (1990) Advances in the management of victims struck by ruptured intracranial aneurysms. Neuro Research 12: 3–11

    Google Scholar 

  23. Mathiesen T, Lindquist C (1990) Delayed brainstem ischemia following rupture of a basilar artery aneurysm and its reversal by Nimodipine. Acta Neurol Scand 82: 150–152

    Google Scholar 

  24. Mee E, Dorrance D, Lowe Det al (1988) Controlled study of Nimodipine in aneurysm patients treated early after subarachnoid hemorrhage. Neurosurgery 22: 484–491

    Google Scholar 

  25. Nishioka H, Torner JC, Graf CJet al (1984) Cooperative study of intracranial aneurysmy and subarachnoid hemorrhage: a long-term prognostic study. Arch Neuro 41: 1142–1147

    Google Scholar 

  26. Oehman J, Heiskanen O (1988) Effect of Nimodipine on the outcome of patients after aneurysmal subarachnoid hemorrhage and surgery. J Neurosurg 69: 683–686

    Google Scholar 

  27. Oehman J, Heiskanen O (1989) Timing of operation for ruptured supratentorial aneurysmy: a prospective randomized study. J Neurosurg 70: 55–60

    Google Scholar 

  28. Oehman J, Servo A, Heiskanen O (1991) Long-term effects of Nimodipine on cerebral infarcts and outcome after aneurysmal subarachnoid hemorrhage and surgery. J Neurosurg 74: 8–13

    Google Scholar 

  29. Pellettieri L, Bolander H, Carlsson Het al (1988) Nimodipine treatment of selected good-risk patients with subarachnoid hemorrhage: no significant difference between present and historical results. Surg Neurol 30: 180–186

    Google Scholar 

  30. Petruk KC, West M, Mohr Get al (1988) Nimodipine treatment in poor-grade aneurysm patients. Results of a multicenter double-blind placebo-controlled trial. J Neurosurg 68: 505–517

    Google Scholar 

  31. Pickard JD, Murray GD, Illingworth Ret al (1989) Effect of oral Nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm Nimodipine trial. BMJ 298: 636–642

    Google Scholar 

  32. Pickard JD, Murray GD, Illingworth Ret al (1989) Nimodipine and cerebral ischaemia following subarachnoid haemorrhage. Br J Neurosurg 3: 529–532

    Google Scholar 

  33. Pickard JD, Murray GD, Illingworth Ret al (1990) Oral Nimodipine and cerebral ischaemia following subarachnoid haemorrhage. BJCP 44: 66–68

    Google Scholar 

  34. Ravussin P, de Tribolet N (1993) Total intravenous anesthesia with propofol for burst supression in cerebral aneurysm surgery: preliminary report of 42 patients. Neurosurgery 32: 236–240

    Google Scholar 

  35. Robinson MJ, Teasdale GM (1990) Calcium antagonists in the management of subarachnoid hemorrhage. Cerebrovasc Brain Metab Rev 2: 205–226

    Google Scholar 

  36. Säveland H, Hillman J, Brandt Let al (1992) Overall outcome in aneurysmal subarachnoid hemorrhage. A prospective study from neurosurgical units in Sweden during a 1-year period. J Neurosurg 76: 729–736

    Google Scholar 

  37. Schmidt JF, Waldemar G, Paulson OB (1991) The acute effect of Nimodipine on cerebral blood flow, its CO2 reactivity, and cerebral oxygen metabolism in human volunteers. Acta Neurochir (Wien) 111: 49–53

    Google Scholar 

  38. Seiler RW, Reulen HJ, Huber Pet al (1988) Outcome of aneurysmal subarachnoid hemorrhage in a hospital population: a prospective study including early operation, intravenous Nimodipine, and transcranial doppler ultrasound. Neurosurgery 23: 598–604

    Google Scholar 

  39. Solomon RA, Fink ME (1987) Current strategies for the management of aneurysmal subarachnoid hemorrhage. Arch Neuro 44: 769–774

    Google Scholar 

  40. Teasdale G, Mendelow AD, Graham DIet al (1990) Efficacy of Nimodipine in cerebral ischemia or hemorrhage. Stroke 21 [Suppl IV]: 123–124

    Google Scholar 

  41. Tettenborn D, Dycka J (1990) Prevention and treatment of delayed ischemic dysfunction in patients with aneurysmal subarachnoid hemorrhage. Stroke 21 [Suppl IV]: 85–89

    Google Scholar 

  42. Wascher TM, Spetzler RF (1992) Current concepts in aneurysmal subarachnoid hemorrhage. Crit Rev Neurosurg 2: 1–14

    Google Scholar 

  43. Welty TE, Horner TG (1990) Pathophysiology and treatment of subarachnoid hemorrhage. Clin Pharmacy 9: 35–40

    Google Scholar 

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Porchet, F., Chioléro, R. & de Tribolet, N. Hypotensive effect of nimodipine during treatment for aneurysmal subarachnoid haemorrhage. Acta neurochir 137, 62–69 (1995). https://doi.org/10.1007/BF02188783

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