Abstract
The effects of hyperdynamic therapy using dobutamine and clinical significance of stroke-CBF, on patients with cerebral vasospasm are here reported. Twenty-six out of 75 (35%) patients developed delayed neurological deficits. The ischemic symptoms of 24 of these patients disappeared after treatment with dobutamine, while the CBF, heart rate and cardiac output increased, although there were no significant elevations in arterial pressure and stroke-SVRI (meaning the systemic vascular resistance index for every pulse beat). This can be done with little difficulty. All clinical results to date are satisfactory. The CBF of symptomatic vasospasm patients increased well, depending on the increase of the cardiac output, not on arterial pressure. However, CT scans on 3 of the 26 patients who had marked tachycardia, showed multiple ischemic lesions, and 1 patient died due to severe brain swelling. In these 3 patients, CBF and stroke-CBF (CBF divided by the heart rate, meaning the CBF for every pulse beat) decreased markedly. The decrease of stroke-CBF may have contributed to the decrease in both the intravascular blood volume and the inside pressure of the spastic arteries for every pulse beat, causing impairment of cerebral circulation.
In the post-operative management for vasospasm, hyperdynamic therapy with dobutamine was effective, and caused no side effects. It is important to control dehydration and marked tachycardia, and thereby prevent a stroke volume and stroke-CBF decrease. Patients with vasospasm should be treated in conjunction with the monitoring of cardiac functions. A value of systemic arterial pressure would not be available to evaluate cerebral circulation.
