Barbiturate Coma Therapy in Severe and Refractory Vasospasm Following Subarachnoid Hemorrhage.
- Author:
Dong Hwa HEO
1
;
Chul HU
;
Sung Min CHO
;
Kum WHANG
;
Jhin Soo PYEN
;
Hun Joo KIM
Author Information
1. Department of Neurosurgery, Wonju College of Medicine, Yonsei University, Wonju, Korea.
- Publication Type:Original Article
- Keywords:
Subarachnoid hemorrhage;
Vasospasm;
Barbiturate coma therapy
- MeSH:
Brain;
Coma*;
Follow-Up Studies;
Humans;
Papaverine;
Prognosis;
Sleep Stages;
Subarachnoid Hemorrhage*;
Tomography, X-Ray Computed
- From:Journal of Korean Neurosurgical Society
2003;33(2):142-148
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVE: This study is designed to evaluate the therapeutic effects and prognostic factors for barbituate coma therapy(BCT)in severe and refractory vasospasm following subarachnoid hemorrhage. METHODS: Barbiturate coma therapy was used in 18 patients with severe and refractory vasospasm in spite of "3-H therapy" and intra-arterial papaverine infusion. The authors analyzed the clinical parameters including Glasgow Coma Scale(GCS), electroenceplographic finding, and brain computerized tomography(CT) scan findings in relation to outcome at discharge. RESULTS: Among 18 patients, burst suppression pattern could be obtained in 17. In cases with good outcome, the duration elapsed from coma to drowsiness after BCT was 14.09+/-5.82 days and GCS score at this time was significant in the prediction of final outcome(p<0.05). Patients with ideal burst suppression pattern attainable more than 24 to 48 hours showed good outcome in 81.8%(p<0.05). The group that showed focal low density in the brain CT scan taken before BCT fared better prognosis compared with that of multifocal or diffuse low density(p<0.05), and patients with resolution of perimesencephalic cistern effacement on follow-up brain CT scan taken 48 hours after BCT showed better prognosis(p<0.05). Overall, 72.2% showed improvement of GCS score by 2 or more, and good outcome was noted in 50%. CONCLUSION: The barbiturate coma therapy seems to have a beneficial therapeutic effect on severe and refractory vasospasm and can be considered as a useful therapeutic modality.
