Abstract
Medical treatment of patients with severe subarachnoid hemorrhage (SAH) and severe vasospasm still poses many problems and the prognosis of these patients is poor. In the present study, we performed barbiturate therapy on 22 cases of severe SAH and 17 cases of severe vasospasm, and obtained good results. One third of the 22 cases of severe SAH treated with barbiturate had an excellent outcome, another 1/3 a good outcome and the last 1/3 a poor otucome. Barbiturate therapy was especially effective with cases accompanied by intracerebral hematoma. In addition, early initiation of the therapy and/or long-term continuation of the therapy for more than two weeks tended to result in a good outcome.
On the other hand, the effectiveness of barbiturate therapy on the 17 cases of severe vasospasm was not necessarily good (the mortality rate reached 41%). In these spasm cases, barbiturate therapy was more effective when the therapy was started before the level of consiousness decreased to stupor. Also, it should be kept in mind that the decrease of blood pressure at the start of the barbiturate therapy can possibly aggravate the cerebral ischemia; therefore, the control of blood pressure is critical factor in the effectiveness of the therapy.
The following side effects of the therapy were noted in our series: 15 cases of liver malfunction (38%), 10 cases of hypotension (26%), four cases of pneumonia (10%) and two cases of pancreatitis (5%). One of the patients complicated with pneumonia died, suggesting that respiratory control to prevent pneumonia is important during the therapy.
