Abstract
Cerebral vasospasm occurs, following subarachnoid haemorrhage, in the majority of patients and is accompanied by cerebral ischaemia in 30%. The objectives of this article are to review (1) the effects of subarachnoid haemorrhage and vaso-spasm on cerebral blood flow(CBF); (2) the effects of induced hypotension and hypocapnia on CBF in these patients; (3) current therapy for cerebral ischaemia from vasospasm. The medical literature was searched using Index Medicus; for the period 1983–90 this search was done on a computer with the CD-ROM version of Index Medicus, Silver Platter®. Papers were selected on the basis of validity and applicability to clinical practice; animal studies are included when human data is lacking. Cerebral vasospasm may decrease cerebral blood flow, disturb autoregulation and place the patient at risk for delayed cerebral ischaemia. Intraoperative induced hypotension and hypocapnia can decrease CBF further, although effects of either on outcome have not been evaluated. Calcium antagonists are effective for both the prevention and the treatment of delayed cerebral ischaemia. Of the mechanical treatments, systemic-arterial hypertension has the firmest scientific foundation, although this is frequently combined with haemodilution and blood volume expansion. There is a need for randomized clinical trials to assess the efficacy of these latter treatments.
Résumé
L’hémorragie subarachnoïdienne s’accompagne souvent d’un vasospasme, ce qui provoque une ischémie cérébrate dans 30% des cas. Cet article fait le point 1) sur les effets d’une hémorragie subarachnoïdienne et du vasospasme sur le débit sanguin cerebral (CBF), 2) sur les effets de l’hypotension délibérée et de l’hypocapnie sur le CBF chez ces malades, et 3) sur le traitement de l’ischémie cérébrate provoquée par un vasospasme. Les articles pertinents out été repérés à l’aide de l’Index Medicus. Pour les années 1983–1990, nous vons utilisé Silver Platter®, la version informatisée CD-ROM de l’Index Medicus. On a retenu les articles pertinents, applicables à la pratique clinique et on a inclus les études expérimentales chez les animaux lorsque l’on ne possedait pas de données chez les humains. Le vasospasme pent diminuer le debit sanguin cerebral et deranger les mecanismes d’autorégulation. Le sujet risque done une ischemie cérébrate. Durant l’anesthésie, l’hypotension et l’hypocapnie délibérées peuvent réduire le CBF, mais on ne connait pas les effets de ces interventions sur les résultats. On peut prevenir et trailer l’ischémie cérébrate due au vasospasme à l’aide d’antagonistes du calcium. Parmi les traitements hémodynamiques, celui qui s’appuie le plus sur des fondements scientifiques surs est l’hypertension artérielle. Toutefois, on l’utilise souvent en conjonction avec l’hémodilulion et l’augmentation du volume circulant. On manque detudes cliniques à double insu pour l’évaluation de ces traitements.
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Archer, D.P., Shaw, D.A., Leblanc, R.L. et al. Haemodynamic considerations in the management of patients with subarachnoid haemorrhage. Can J Anaesth 38, 454–470 (1991). https://doi.org/10.1007/BF03007583
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DOI: https://doi.org/10.1007/BF03007583