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Vasopressin continuous infusion improves intracranial pressure and patient outcomes after surgical clipping or endovascular coiling of cerebral aneurysm


1 Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
2 Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt

Correspondence Address:
Ahmed Said Elgebaly,
Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, 19 Elfaloga Street, Elgharbia, Tanta
Egypt
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aer.AER_30_19

Background: Hypertensive therapy prevents vasospasm-related delayed ischemic neurologic deficit and infarcts. New alternatives would include vasopressin which has vasoconstrictive effects and positive influence on cerebral perfusion pressure (CPP) and intracranial pressure (ICP). Aims: The aim of this study is to demonstrate the value of vasopressin intravenous infusion (IVI) in decreasing ICP and preventing vasospasm following surgical clipping or endovascular coiling. Settings and Design: A triple-blind prospective randomized controlled study. Subjects and Methods: Thirty patients, 25–60 years, both genders, had undergone surgical clipping or endovascular coiling for a cerebral aneurysm, World Federation of Neurosurgical Societies (WFNS) grade 1–3 (15 patients in each); Group I (Vasopressin): 0.1–0.4 unit/min and Group II (Norepinephrine): 5–20 ug/min with target systolic blood pressure 160–180 mmHg. Statistical Analysis: SPSS version 25 software was used for analysis. Results: Invasive mean arterial pressure (MAP) showed the insignificant difference between the two groups, but ICP showed a significant decrease in Group V from hour 24 to 168 hence calculated CPP showed a significant increase in Group V at most times from hour 36 to 168. Glasgow Coma Scale showed a significant decrease in Group N from hour 138 due to the occurrence of vasospasm. The incidence of vasospasm, mechanical ventilation, and 28-day mortality were significantly lower in Group V with 81% risk reduction of vasospasm and better survival. Conclusion: Vasopressin IVI improved ICP, MAP, CPP and patient outcomes safely by reducing the incidence of cerebral vasospasm, and 28-day mortality after clipping or coiling of the cerebral aneurysm.


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    -  Elgebaly AS
    -  Abd El Ghafar MS
    -  Fathy SM
    -  Shaddad MN
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