Vasopressin Continuous Infusion Improves Intracranial Pressure and Patient Outcomes after Surgical Clipping or Endovascular Coiling of Cerebral Aneurysm.

ABSTRACT

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.