Abstract
Gamma-hydroxybutyrate (GHB), a suspected neurotransmitter, has sedative properties, reducing brain metabolism and body temperature and thus inducing effects resembling hibernation. Introduced as a narcotic 25 years ago, it has been employed in recent years for basic sedation of intensive-care patients in need of long-term respiratory support. In this study we analysed the effects of continuous GHB application in 19 patients suffering from increased intracranial pressure (ICP) subarachnoid haemorrhage (SAH), or both. GHB, which is only available as a sodium salt, frequently causes hypernatremia and metabolic alcalosis when given continually in dosages higher than 12 mg/kg body weight per hour. GHB is, therefore, often limited to preserve the potential usefulness of controlled hyperventilation or osmotherapy, respectively, when ICP increases. In 7 out of 8 patients with total infarctions in the territory of the middle cerebral artery GHB could not prevent the development of a malignant brain edema. The survivors with territorial infarctions or SAH in whom ICP was monitored showed no critical decreases in cerebral perfusion pressure during GHB application. Early GHB administration seemed beneficial in the prevention of vasospasm subsequent to severe SAH. The intracranial blood flow velocities did not exceed 90 cm/s in all three cases treated with GHB within the first three days after SAH, whereas three out of four cases without GHB showed marked acceleration with values over 90 cm/s. In two patients, the administration of GHB after the development of severe vasospasm was followed by a continuous decrease of flow velocities in the cerebral arteries.
Published Version
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