脳血管攣縮に対するbarbiturate coma therapy

Abstract

Barbiturate coma therapy was employed in six patients with subarachnoid hemorrhage of grade III and IV to prevent cerebral infarction due to vasospasm after rupture of a cerebral aneurysm. A thick subarachnoid clot and tight brain were shown on CT scans in all of the patients.Barbiturate coma therapy was begun between one and nine days (mean, 5.5 days) after subarachnoid hemorrhage and continued for 49 to 98 hours (mean, 69.3 hours). It was maintained with a continuous intravenous infusion of between 5 and 10mg/kg/hour of thiamylal sodium to achieve burst suppression on the electroencephalogram.Two patients recovered with no neurological deficits, one patient was left in a persistent vegetative state, and three patients died. One of the patients who died recovered to an alert state after barbiturate coma therapy but died from pulmonary embolism 40 days after the subarachnoid hemorrhage.From a reveiw of these six cases, we consider it appropriate for grade IV patients with increased intracranial pressure to receive barbiturate coma therapy immediately after operation and for grade III patients with increased intracranial pressure to receive it immediately after the onset of delayed neurological deficits due to vasospasm.