Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2018.09.004
Brazilian Journal of Anesthesiology
Scientific Article

Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study

Efeitos do sulfato de magnésio e da milrinona sobre o vasoespasmo cerebral após hemorragia subaracnoidea por aneurisma: estudo randômico

Rabie Soliman; Gomaa Zohry

http://dx.doi.org/10.1016/j.bjane.2018.09.004 Braz J Anesthesiol, vol.69, n1, p.64-71, 2019
PDF English
PDF Português
Downloads: 0
Views: 813

Abstract

Abstract Background: Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. Methods: The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500 mg.day-1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5 µg.kg-1.min-1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity ≥ 120 cm.s-1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%). Results: The mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p < 0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p = 0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p = 0.036, p = 0.012, p = 0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p = 0.012). Conclusions: The incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.

Keywords

Magnesium sulphate, Milrinone, Aneurysmal subarachnoid hemorrhage, Cerebral vasospasm

Resumo

Resumo Justificativa: A hemorragia subaracnoidea por aneurisma é uma importante causa de morte prematura e de incapacidade em todo o mundo. O sulfato de magnésio mostra um efeito neuroprotetor e reverte o vasoespasmo cerebral. A milrinona também é usada no tratamento de vasoespasmo cerebral. O objetivo do presente estudo foi comparar o efeito profilático do sulfato de magnésio e da milrinona sobre a incidência de vasoespasmo cerebral após hemorragia subaracnoidea. Métodos: O estudo incluiu 90 pacientes com hemorragia subaracnoidea por aneurisma randomicamente distribuídos (randomização simples) em dois grupos: sulfato de magnésio foi administrado em infusão de 500 mg.dia-1 sem dose de ataque durante 21 dias. O Grupo B recebeu milrinona em infusão de 0,5 µg.kg-1·min-1 sem dose de ataque durante 21 dias. O vasoespasmo cerebral foi diagnosticado pela velocidade média do fluxo sanguíneo cerebral na artéria cerebral envolvida (velocidade média do fluxo ≥ 120 cm.s-1), a deterioração neurológica por escala de coma de Glasgow ou angiografia (diminuição do diâmetro da artéria cerebral envolvida > 25%). Resultados: A velocidade média do fluxo sanguíneo cerebral diminuiu significativamente no grupo magnésio em comparação com o grupo milrinona nos dias 7, 14 e 21 (p < 0,001). A incidência de vasoespasmo cerebral diminuiu significativamente com o magnésio em comparação com milrinona (p = 0,007). A escala de coma de Glasgow melhorou significativamente no grupo magnésio em comparação com o grupo milrinona nos dias 7, 14 e 21 (p = 0,036, p = 0,012, p = 0,016, respectivamente). A incidência de hipotensão foi maior com milrinona do que com magnésio (p = 0,012). Conclusões: A incidência de vasoespasmo cerebral após hemorragia subaracnoidea por aneurisma foi significativamente menor e a escala de coma de Glasgow significativamente melhor com magnésio em comparação com milrinona. A milrinona foi associada a uma maior incidência de hipotensão e necessidade de dopamina e norepinefrina em comparação com o magnésio.

Palavras-chave

Sulfato de magnésio, Milrinona, Hemorragia subaracnoidea por aneurisma, Vasoespasmo cerebral

References

Harrod CG, Bendok BR, Batjer HH. Prediction of cerebral vasospasm in patients presenting with aneurysmal subarachnoid haemorrhage: a review. Neurosurgery. 2005;56:633-54.

Lee KH, Lukovits T, Friedman JA. Triple-H therapy for cerebral vasospasm following subarachnoid haemorrhage. Neurocrit Care. 2006;4:68-76.

van den Bergh WM, Algra A, van Kooten F. Magnesium sulfate in aneurysmal subarachnoid haemorrhage: a randomized controlled trial. Stroke. 2005;36:1011-5.

Stippler M, Crago E, Levy EI. Magnesium infusion for vasospasm prophylaxis after subarachnoid haemorrhage. J Neurosurg. 2006;105:723-9.

Johnson JW, Ascher P. Voltage-dependent block by intracellular Mg2+ of N-methyl-d-aspartate-activated channels. Biophys J. 1990;57:1085-90.

van den Bergh WM, Algra A, van der Sprenkel JW. Hypomagnesemia after aneurysmal subarachnoid haemorrhage. Neurosurgery. 2003;52:276-82.

Ortega-Gutierrez S, Mayer SA. Is the magnesium era for aneurysmal subarachnoid haemorrhage over?. Curr Neurol Neurosci Rep. 2010;10:420-2.

Arakawa Y, Kikuta K, Hojo M. Milrinone for the treatment of cerebral vasospasm after subarachnoid haemorrhage: report of seven cases. Neurosurgery. 2001;48:723-30.

Arakawa Y, Kikuta K, Hojo M. Milrinone reduces cerebral vasospasm after subarachnoid haemorrhage grade IV or V. Neurol Med Chir (Tokyo). 2004;44:393-401.

Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6:1-9.

Nicoletto HA, Burkman MH. Transcranial Doppler series part II: performing a transcranial Doppler. Am J Electroneurodiagn Technol. 2009;49:14-27.

Westermaier T, Stetter C, Vince GH. Prophylactic intravenous magnesium sulfate for treatment of aneurysmal subarachnoid haemorrhage: a randomized, placebo-controlled, clinical study. Crit Care Med. 2010;38:1284-90.

Chia RY, Hughes RS, Morgan MK. Magnesium: a useful adjunct in the prevention of cerebral vasospasm following aneurysmal subarachnoid haemorrhage. J Clin Neurosci. 2002;9:279-81.

Muroi C, Terzic A, Fortunati M. Magnesium sulfate in the management of patients with aneurysmal subarachnoid haemorrhage: a randomized, placebo-controlled, dose-adapted trial. Surg Neurol. 2008;69:33-9.

Prevedello DM, Cordeiro JG, de Morais AL. Magnesium sulfate: role as possible attenuating factor in vasospasm morbidity. Surg Neurol. 2006;65:S1-S20.

Yahia AM, Kirmani JF, Qureshi AI. The safety and feasibility of continuous intravenous magnesium sulfate for prevention of cerebral vasospasm in aneurysmal subarachnoid haemorrhage. Neurocrit Care. 2005;3:16-23.

Zhao XD, Zhou YT, Zhang X. A meta-analysis of treating subarachnoid haemorrhage with magnesium sulfate. J Clin Neurosci. 2009;16:1394-7.

Dorhout Mees SM, Algra A, Vandertop WP. Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomized placebo-controlled trial. Lancet. 2012;380:44-9.

Golshani K, Ferrell A, Zomorodi A. A review of the management of posterior communicating artery aneurysms in the modern era. Surg Neurol Int. 2010;1:88.

Taylor CL, Kopitnik Jr. TA, Samson DS. Treatment and outcome in 30 patients with posterior cerebral artery aneurysms. J Neurosurg. 2003;99:15-22.

Schievink WI, Wijdicks EF, Piepgras DG. The poor prognosis of ruptured intracranial aneurysms of the posterior circulation. J Neurosurg. 1995;82:791-5.

Golan E, Vasquez D, Ferguson N. Prophylactic magnesium for improving neurologic outcome after aneurysmal subarachnoid haemorrhage: systematic review and meta-analysis. J Crit Care. 2013;28:173-81.

Wong GK, Poon WS, Chan MT. Intravenous magnesium sulphate for aneurysmal subarachnoid haemorrhage (IMASH): a randomized, double-blinded, placebo-controlled, multicenter phase III trial. Stroke. 2010;41:921-6.

Suarez JI. Magnesium sulfate administration in subarachnoid haemorrhage. Neurocrit Care. 2011;15:302-7.

Reddy D, Fallah A, Petropoulos JA. Prophylactic magnesium sulfate for aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis. Neurocrit Care. 2014;21:356-64.

Mees S, Algra A, Vendertop W. Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomized placebo controlled trial. Lancet. 2012;380:44-9.

Fraticelli AT, Cholley BP, Losser MR. Milrinone for the treatment of cerebral vasospasm after aneurysmal subarachnoid haemorrhage. Stroke. 2008;39:893-8.

Ghanem MA, Shabana AM. Effects of milrinone continuous intravenous infusion on global cerebral oxygenation and cerebral vasospasm after cerebral aneurysm surgical clipping. Egyptian J Anaesth. 2014;30:73-82.

Romero CM, Morales D, Reccius A. Milrinone as a rescue therapy for symptomatic refractory cerebral vasospasm in aneurysmal subarachnoid haemorrhage. Neurocrit Care. 2009;11:165-71.

Lannes M, Teitelbaum J, del Pilar Cortés M. Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid haemorrhage: the Montreal Neurological Hospital Protocol. Neurocrit Care. 2012;16:354-62.

Lasry O, Marcoux J. The use of intravenous milrinone to treat cerebral vasospasm following traumatic subarachnoid haemorrhage. Springerplus. 2014;3:1-7.

Shankar JJ, dos Santos MP, Deus-Silva L. Angiographic evaluation of the effect of intra-arterial milrinone therapy in patients with vasospasm from aneurysmal subarachnoid haemorrhage. Neuroradiology. 2011;53:123-8.

Bouchard M, Verreault S, Gariépy JL. Intra-arterial milrinone for reversible cerebral vasoconstriction syndrome. Headache. 2009;49:142-5.

Schmidt U, Bittner E, Pivi S. Haemodynamic management and outcome of patients treated for cerebral vasospasm with intraarterial nicardipine and/or milrinone. Anesth Analg. 2010;110:895-902.

Nishiguchi M, Ono S, Iseda K. Effect of vasodilation by milrinone, a phosphodiesterase III inhibitor, on vasospastic arteries after a subarachnoid haemorrhage in vitro and in vivo: effectiveness of cisternal injection of milrinone. Neurosurgery. 2010;66:158-64.

5dcafb1f0e8825263803b87a rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections