Indication for, the method of, and result of the prophylactic use of barbiturate therapy (B-therapy) against cerebral infarct from cerebral arterial vasospasm due to ruptured aneurysm
Miyagi, K.; Ishijima, B.; Sato, F.; Kubota, T.; Sakuraya, N.
No Shinkei Geka. Neurological Surgery 12(3 Suppl): 303-310
1984
ISSN/ISBN: 0301-2603 PMID: 6462337 Document Number: 241683
A review of 45 cerebral vasospasm cases for cerebral infarct under computer tomography (CT) scanner and based on activities of daily living (ADL) resulted in the finding that, of 19 cases with vasospasm of "diffuse, severe" grade, 14 cases were rated "poor (disabled)" to "dead": CT-diagnosed cerebral infarct was found in 4 out of 6 cases. From this, it was believed that indication for B-therapy was clinically significant vasospasm (diffuse, severe), which falls under the clinical grade of III or IV by Hunt and Kosnik without considering such incidental condition as severe vasospasm. After B-therapy, 45% showed ADL of at least "fair". CT-diagnosed cerebral infarct was found in 4 out of 10 cases. None died from complications as a result of B-therapy. The examination of ineffectual cases pointed to the importance of the first choice application of B-therapy, the continuation of the therapy as long as vasospasm continues, and the sustenance of cerebral perfusion pressure by the use of vasopressor (Dopamine) to offset the hypotensive effect of barbiturate. With these points of care exercised, the B-therapy is believed to achieve good results.