Hyperdynamic therapy for cerebral vasospasm

Abstract

The effects of hyperdynamic therapy using dobutamine on vasospasm patients are reported. Of 280 patients with subarachnoid hemorrhage who underwent acute aneurysm surgery, 105 (37.5%) developed delayed neurological deficits. CT scans of 27 (9.6%) out of 105 patients showed ischemic lesions, however 268 (95.7%) patients were normal or independent at discharge from hospital. In symptomatic vasospasm patients treated with dobutamine, no significant correlation was observed between the changes in CBF and arterial pressure. In patients with symptomatic vasospasm, whose CT scans showed ischemic lesions, CBF and stroke-CBF (the CBF for every pulse beat=CBF divided by heart rate) decreased markedly, compared with the patients who had no ischemic lesions. The decrease in stroke-CBF may have contributed to the decrease in the pulsatility of the spastic arteries for every pulse beat, causing impairment of cerebral circulation. In post-operative management for vasospasm, hyperdynamic therapy using dobutamine is effective and without side effects. It is important to keep vasospasm patients under hyperdynamic conditions, and prevent cardiac output and stroke-CBF decrease. Patients with vasospasm should be treated in conjunction with monitoring of cardiac function, as systemic arterial pressure would not be available to evaluate cerebral circulation.