Neurosurgery Blog: Acute Effects of Nimodipine on Cerebral Vasculature and Brain Metabolism in High Grade Subarachnoid

Abstract

Background

Nimodipine is the only medication shown to improve outcomes after aneurysmal subarachnoid hemorrhage (SAH). Preliminary theories regarding the mechanism by which it prevents vasospasm have been challenged. The acute physiologic and metabolic effects of oral Nimodipine have not been examined in patients with poor-grade SAH.

Methods

This is an observational study performed in 16 poor-grade SAH patients undergoing multimodality monitoring who received oral Nimodipine as part of routine clinical care. A total of 663 doses of Nimodipine were observed. Changes in physiologic measurements including MAP, CPP, ICP, P_btO₂, and CBF were examined.

Results

Administration of oral Nimodipine was associated with a 1.33 mmHg decrease in MAP (P < 0.001) and a 1.22 mmHg decrease in CPP (P < 0.001). When administration of Nimodipine was associated with MAP decreases, P_btO₂ (1.03 mmHg; P < 0.001) and CBF (0.39 ml/100 g/min; P = 0.002) also decreased.

Conclusions

Despite CPP targeted therapy with vasopressor medication, oral Nimodipine was associated with a decrease in MAP and CPP. When Nimodipine administration was associated with a decrease in MAP, there were concomitant drops in P_btO₂ and CBF. These findings suggest that MAP support after oral Nimodipine may be important to maintain adequate CBF in patients with poor-grade subarachnoid hemorrhage.

Content Type Journal Article
Pages 1-5
DOI 10.1007/s12028-012-9670-8
Authors
- H. Alex Choi, Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, Milstein Hospital Building 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA
- Sang-Bae Ko, Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, Milstein Hospital Building 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA
- Huahiou Chen, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
- Emily Gilmore, Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, Milstein Hospital Building 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA
- Amanda M. Carpenter, Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, Milstein Hospital Building 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA
- Danielle Lee, Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, Milstein Hospital Building 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA
- Jan Claassen, Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, Milstein Hospital Building 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA
- Stephan A. Mayer, Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, Milstein Hospital Building 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA
- J. Michael Schmidt, Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, Milstein Hospital Building 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA
- Kiwon Lee, Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, Milstein Hospital Building 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA
- E. Sander Connelly, Department of Neurosurgery, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Myunghee Paik, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
- Neeraj Badjatia, Division of Neurocritical Care, The Neurologic Institute of New York, Columbia University College of Physicians and Surgeons, Milstein Hospital Building 8 Center, 177 Fort Washington Ave, New York, NY 10032, USA