Safety of intraventricular sodium nitroprusside and thiosulfate for the treatment of cerebral vasospasm in the intensive care unit setting

• Published in: Stroke (1970) Vol. 33; no. 2; pp. 486 - 492
• Main Authors: THOMAS, Jeffrey E, MCGINNIS
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.02.2002; American Heart Association, Inc
• Subjects: Adult; Aged; Biological and medical sciences; Brain - blood supply; Brain - drug effects; Brain - surgery; Cardiovascular system; Catheterization; Critical Care; Drug Therapy, Combination; Female; Humans; Infusion Pumps; Injections, Intraventricular; Male; Medical sciences; Middle Aged; Neurologic Examination; Nitroprusside - administration & dosage; Nitroprusside - adverse effects; Pharmacology. Drug treatments; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnosis; Survival Rate; Thiosulfates - administration & dosage; Thiosulfates - adverse effects; Treatment Outcome; Ultrasonography, Doppler, Transcranial; Vasodilator agents. Cerebral vasodilators; Vasospasm, Intracranial - complications; Vasospasm, Intracranial - diagnosis; Vasospasm, Intracranial - therapy; Ventriculostomy; Intensive care; Thiosulfates; Prognosis; Vasodilator agent; Cardiovascular disease; Hemorrhage; Vascular disease; Adult; Complication; Vasospasm; Cerebrovascular disease; Human; Intracranial; Nervous system diseases; Drug combination; Cerebral ventricle; Cerebral disorder; Dissecting aneurysm; Sodium nitroprusside; Chemotherapy; Treatment; Central nervous system disease; Intracerebral administration; Subarachnoid; Antihypertensive agent
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/hs0202.103410

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. 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. Good outcome was observed in 7 of 8 vasospasm patients presenting with clinical subarachnoid hemorrhage grade > or =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. 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.