INTRACRANIAL-PRESSURE MONITORING DURING INTRAARTERIAL PAPAVERINE INFUSION FOR CEREBRAL VASOSPASM

PURPOSE: Intraarterial papaverine infusions are performed to reverse c erebral arterial vasospasm resulting from subarachnoid hemorrhage, but such infusions may lead to increases in intracranial pressure (ICP), This study was undertaken to determine when ICP monitoring is indicate d during papaverine treatment. METHODS: Seventy-eight vessels were tre ated in 51 sessions in 28 patients with symptomatic vasospasm, ICP, pa paverine doses, and infusion rates were recorded during treatment sess ions, The procedural data, Hunt and Hess scores, Fisher grades, Glasgo w Coma Scale scores, and ages for all subjects were reviewed and analy zed retrospectively. RESULTS: Baseline ICP ranged from 0 to 34 mm Hg, With typical papaverine doses of 300 mg per territory and infusion tim es ranging from 5 to 60 minutes per vessel, ICP increases above baseli ne during papaverine infusion ranged from 0 to 60 mm Hg, Significant ( greater than or equal to 20 mm Hg) ICP increases during therapy were o bserved even in patients with low baseline ICP and with papaverine inf used at the slowest rate, Patients with a baseline ICP of more than 15 mm Hg were much more likely to have significant ICP increases than we re patients,vith a baseline ICP of 0 to 15 mm Hg, Hunt and Hess scores , Fisher grades, age, and Glasgow Coma Scale scores on admission and i mmediately before treatment did not correlate with ICP increases durin g papaverine infusion, Patients with ICP increases of more than 10 mm Hg during therapy were more likely to experience adverse clinical even ts than were patients with ICP increases of less than or equal to 10 m m Hg, Reduction in the rate of papaverine infusion, or termination of infusion, resulted in reversal of drug-induced ICP elevation. CONCLUSI ON: ICP monitoring during intraarterial papaverine infusions for cereb ral vasospasm is recommended for all patients and is particularly impo rtant for patients with elevated baseline ICP, Continuous ICP monitori ng facilitates safe and time-efficient drug delivery.