[Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study]

Rabie Soliman, Gomaa Zohry, Rabie Soliman, Gomaa Zohry

Abstract

Background: Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage.

Methods: The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500 mg.day−1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5 μg.kg−1.min−1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity ≥ 120 cm.s−1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%).

Results: The mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p < 0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p = 0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p = 0.036, p = 0.012, p = 0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p = 0.012).

Conclusions: The incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.

Keywords: Aneurysmal subarachnoid hemorrhage; Cerebral vasospasm; Hemorragia subaracnoidea por aneurisma; Magnesium sulphate; Milrinona; Milrinone; Sulfato de magnésio; Vasoespasmo cerebral.

Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
(A) Mean cerebral blood flow velocity of patients and (B) Glasgow coma scale of patients. Day 1, the 1st day from the onset of subarachnoid hemorrhage; Day 7, the 7th day from the onset of subarachnoid hemorrhage; Day 14, the 14th day from the onset of subarachnoid hemorrhage; Day 21, the 21st day from the onset of subarachnoid hemorrhage. Group MG, magnesium group; Group ML, milrinone group. *Statistically significant (p < 0.05) between the two groups. †p < 0.05 versus baseline.

References

    1. Harrod C.G., Bendok B.R., Batjer H.H. Prediction of cerebral vasospasm in patients presenting with aneurysmal subarachnoid haemorrhage: a review. Neurosurgery. 2005;56:633–654.
    1. Lee K.H., Lukovits T., Friedman J.A. Triple-H therapy for cerebral vasospasm following subarachnoid haemorrhage. Neurocrit Care. 2006;4:68–76.
    1. van den Bergh W.M., Algra A., van Kooten F., et al. Magnesium sulfate in aneurysmal subarachnoid haemorrhage: a randomized controlled trial. Stroke. 2005;36:1011–1015.
    1. Stippler M., Crago E., Levy E.I., et al. Magnesium infusion for vasospasm prophylaxis after subarachnoid haemorrhage. J Neurosurg. 2006;105:723–729.
    1. Johnson J.W., Ascher P. Voltage-dependent block by intracellular Mg2+ of N-methyl-d-aspartate-activated channels. Biophys J. 1990;57:1085–1090.
    1. van den Bergh W.M., Algra A., van der Sprenkel J.W., et al. Hypomagnesemia after aneurysmal subarachnoid haemorrhage. Neurosurgery. 2003;52:276–282.
    1. Ortega-Gutierrez S., Mayer S.A. Is the magnesium era for aneurysmal subarachnoid haemorrhage over? Curr Neurol Neurosci Rep. 2010;10:420–422.
    1. Arakawa Y., Kikuta K., Hojo M., et al. Milrinone for the treatment of cerebral vasospasm after subarachnoid haemorrhage: report of seven cases. Neurosurgery. 2001;48:723–730.
    1. Arakawa Y., Kikuta K., Hojo M., et al. Milrinone reduces cerebral vasospasm after subarachnoid haemorrhage grade IV or V. Neurol Med Chir (Tokyo) 2004;44:393–401.
    1. Fisher C.M., Kistler J.P., Davis J.M. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6:1–9.
    1. Nicoletto H.A., Burkman M.H. Transcranial Doppler series part II: performing a transcranial Doppler. Am J Electroneurodiagn Technol. 2009;49:14–27.
    1. Westermaier T., Stetter C., Vince G.H., et al. Prophylactic intravenous magnesium sulfate for treatment of aneurysmal subarachnoid haemorrhage: a randomized, placebo-controlled, clinical study. Crit Care Med. 2010;38:1284–1290.
    1. Chia R.Y., Hughes R.S., Morgan M.K. Magnesium: a useful adjunct in the prevention of cerebral vasospasm following aneurysmal subarachnoid haemorrhage. J Clin Neurosci. 2002;9:279–281.
    1. Muroi C., Terzic A., Fortunati M., et al. Magnesium sulfate in the management of patients with aneurysmal subarachnoid haemorrhage: a randomized, placebo-controlled, dose-adapted trial. Surg Neurol. 2008;69:33–39.
    1. Prevedello D.M., Cordeiro J.G., de Morais A.L., et al. Magnesium sulfate: role as possible attenuating factor in vasospasm morbidity. Surg Neurol. 2006;65:S1–S20.
    1. Yahia A.M., Kirmani J.F., Qureshi A.I., et al. The safety and feasibility of continuous intravenous magnesium sulfate for prevention of cerebral vasospasm in aneurysmal subarachnoid haemorrhage. Neurocrit Care. 2005;3:16–23.
    1. Zhao X.D., Zhou Y.T., Zhang X., et al. A meta-analysis of treating subarachnoid haemorrhage with magnesium sulfate. J Clin Neurosci. 2009;16:1394–1397.
    1. Dorhout Mees S.M., Algra A., Vandertop W.P., et al. Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomized placebo-controlled trial. Lancet. 2012;380:44–49.
    1. Golshani K., Ferrell A., Zomorodi A., et al. A review of the management of posterior communicating artery aneurysms in the modern era. Surg Neurol Int. 2010;1:88.
    1. Taylor C.L., Kopitnik T.A., Jr., Samson D.S., et al. Treatment and outcome in 30 patients with posterior cerebral artery aneurysms. J Neurosurg. 2003;99:15–22.
    1. Schievink W.I., Wijdicks E.F., Piepgras D.G., et al. The poor prognosis of ruptured intracranial aneurysms of the posterior circulation. J Neurosurg. 1995;82:791–795.
    1. Golan E., Vasquez D., Ferguson N., et al. Prophylactic magnesium for improving neurologic outcome after aneurysmal subarachnoid haemorrhage: systematic review and meta-analysis. J Crit Care. 2013;28:173–181.
    1. Wong G.K., Poon W.S., Chan M.T., et al. Intravenous magnesium sulphate for aneurysmal subarachnoid haemorrhage (IMASH): a randomized, double-blinded, placebo-controlled, multicenter phase III trial. Stroke. 2010;41:921–926.
    1. Suarez J.I. Magnesium sulfate administration in subarachnoid haemorrhage. Neurocrit Care. 2011;15:302–307.
    1. Reddy D., Fallah A., Petropoulos J.A., et al. Prophylactic magnesium sulfate for aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis. Neurocrit Care. 2014;21:356–364.
    1. Mees S., Algra A., Vendertop W., et al. Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomized placebo controlled trial. Lancet. 2012;380:44–49.
    1. Fraticelli A.T., Cholley B.P., Losser M.R., et al. Milrinone for the treatment of cerebral vasospasm after aneurysmal subarachnoid haemorrhage. Stroke. 2008;39:893–898.
    1. Ghanem M.A., Shabana A.M. Effects of milrinone continuous intravenous infusion on global cerebral oxygenation and cerebral vasospasm after cerebral aneurysm surgical clipping. Egyptian J Anaesth. 2014;30:73–82.
    1. Romero C.M., Morales D., Reccius A., et al. Milrinone as a rescue therapy for symptomatic refractory cerebral vasospasm in aneurysmal subarachnoid haemorrhage. Neurocrit Care. 2009;11:165–171.
    1. Lannes M., Teitelbaum J., del Pilar Cortés M., et al. Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid haemorrhage: the Montreal Neurological Hospital Protocol. Neurocrit Care. 2012;16:354–362.
    1. Lasry O., Marcoux J. The use of intravenous milrinone to treat cerebral vasospasm following traumatic subarachnoid haemorrhage. Springerplus. 2014;3:1–7.
    1. Shankar J.J., dos Santos M.P., Deus-Silva L., et al. Angiographic evaluation of the effect of intra-arterial milrinone therapy in patients with vasospasm from aneurysmal subarachnoid haemorrhage. Neuroradiology. 2011;53:123–128.
    1. Bouchard M., Verreault S., Gariépy J.L., et al. Intra-arterial milrinone for reversible cerebral vasoconstriction syndrome. Headache. 2009;49:142–145.
    1. Schmidt U., Bittner E., Pivi S., et al. Haemodynamic management and outcome of patients treated for cerebral vasospasm with intraarterial nicardipine and/or milrinone. Anesth Analg. 2010;110:895–902.
    1. Nishiguchi M., Ono S., Iseda K., et al. Effect of vasodilation by milrinone, a phosphodiesterase III inhibitor, on vasospastic arteries after a subarachnoid haemorrhage in vitro and in vivo: effectiveness of cisternal injection of milrinone. Neurosurgery. 2010;66:158–164.

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