Authors: (including presenting author): :
Wong YS, Yip HW, Tang WM
Affiliation: :
ICU, TMH ,NTWC
Introduction: :
Cerebral vasospasm remains a significant cause of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (SAH), contributing to substantial morbidity and mortality. Milrinone, a phosphodiesterase III inhibitor, has emerged as a promising therapeutic option for treating vasospasm through its vasodilatory property.
Objectives: :
To investigate a locally developed milrinone infusion regimen would be useful for mitigating vasospasm and its side effect profile.
Methodology: :
We present a retrospective case series of eight patients with aneurysmal SAH who developed cerebral vasospasm and were treated with intravenous milrinone infusion. Patients were monitored using transcranial Doppler (TCD) ultrasonography and clinical assessment. The milrinone protocol involved initiation at 5 mL/hr, escalating to 10 mL/hr after 2 hour if no significant adverse effects occurred, with tolerance for norepinephrine requirements up to 15 mL/hr attributed to milrinone infusion.
Result & Outcome: :
Patient demographics showed an age range of 27-55 years without significant cardiovascular comorbidities. World Federation of Neurosurgical Societies (WFNS) grades range from 1-4 and Fisher scores 1-4. Milrinone infusion duration ranged from 5-7 days. Three out of eight patients experienced treatment interruption: one due to hypotension without central venous access during on call time and one due to escalating norepinephrine requirements to 20 mL/hr. TCD monitoring showed maintained Lindegaard ratios within 6 and mean flow velocities within 200 cm/s for most period for all patients. Two patients demonstrated angiographic improvement following milrinone therapy. One patient developed delayed cerebral infarction.
