Abstract
BackgroundIn patients with subarachnoid hemorrhage (SAH), vasospasm remains one of the major complications. The application of intravenous magnesium sulfate (MgSO4) has been under discussion to prevent cerebral ischemia. Our aim was to examine the impact of early MgSO4 administration on local cerebral microcirculation during microsurgical clipping of SAH-related aneurysms.MethodsThe non-invasive laser-Doppler spectrophotometry system “Oxygen-to-See (O2C)” was used in 14 consecutive patients (11 female, 3 male, median age 56.5±9.7 yrs) with aneurysmatic SAH. A subdural probe measured capillary venous oxygenation (SO2), relative hemoglobin content (rHb), blood cell velocity (velo) and blood flow (flow) in 7 mm tissue depth. Data samples were recorded as baseline immediately before intraoperative application of MgSO4 10% 50 mg/kg body weight and 10 min thereafter. The continuous MgSO4 infusion rate depended on blood pressure (mean arterial pressure > 60-65 mmHg) and lasted a maximum of 60 min.ResultsMgSO4 was administered 2.8 (min. 1.6, max. 15.5) hours after onset of symptoms. Median flow increased significantly by 20.8% (5–68%, p = 0.001). Velo increased 4.9% (1–17%), rHb decreased 1.5% (3–34%) and SO2 decreased 9.4% (8–38%) by trend compared to the baseline values. FiO2 correlated positively with velo (rs = 0.712, p = 0.004), whereas arterial HCO3 correlated negatively with SO2 (rs = −0.599, p = 0.024). Of 14 patients, 2 had symptomatic vasospasm.ConclusionsOur data suggest an increased cerebral blood flow after early intraoperative administration of MgSO4 in patients with SAH. Using a non-invasive laser-Doppler spectrophotometry system, this technique is feasible for continuous real-time monitoring of cerebral microcirculation.Trial registrationDRKS (German Clinical Trial Registry), DRKS00013047, retrospectively registered on September 21st, 2017.
Highlights
In patients with subarachnoid hemorrhage (SAH), vasospasm remains one of the major complications
Subarachnoid hemorrhage (SAH) caused by a ruptured aneurysm occurs in about 700.000 individuals per year worldwide with an approximate incidence of 9 per 100.000 person years [1]
One of the most important factors associated with poor clinical outcome is early or delayed cerebral vasospasm (CVS) [5,6,7]
Summary
In patients with subarachnoid hemorrhage (SAH), vasospasm remains one of the major complications. Subarachnoid hemorrhage (SAH) caused by a ruptured aneurysm occurs in about 700.000 individuals per year worldwide with an approximate incidence of 9 per 100.000 person years [1]. This adds up about 36.000 SAH cases per year in the European Community [2, 3]. A variety of treatment options aiming at the relaxation of smooth muscle in cerebral arteries to prevent CVS and avoid infarctions have been reported, including the application of calcium antagonists, statins, or endothelin receptor antagonists [8]. Magnesium, which physiologically acts as a calcium antagonist, has been suggested as a potential therapeutic agent for CVS
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