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Ann Fr Anesth Reanim. 2007 Nov;26(11):980-4. Epub 2007 Oct 22.

[Systemic treatments of the vasospasm].

[Article in French]

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Pôle d'anesthésie-réanimation et unité de réanimation neurochirurgicale, hôpital Roger-Salengro, CHU de Lille, 59037 Lille cedex, France.


Cerebral vasospasm, a recognized complication of aneurysmal subarachnoid haemorrhage, can lead to delayed ischaemic neurological deficit, and death. The systematic administration of nimodipine confers a modest but real benefit against delayed ischaemic damage. When vasospasm occurs, triple-H therapy (hypervolaemia, hypertension, and haemodilution) has long been advocated in order to increase flow, but its usefulness remains unclear. Cardiac output optimization using inotropic drugs might also be considered in selected patients. In practice, only correction of volume depletion and induced hypertension (after aneurysm has been secured) can be recommended. In addition, according to phase II randomized trials, promising new treatments for vasospasm or its ischaemic complications include magnesium sulfate, the selective endothelin A-receptor antagonist clazosentan, and statins. The simple and safe profile of prophylactic use of statins appears particularly attractive. However, all these potential candidates need further validation through (on-going) clinical phase III trials.

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