Treatment of subarachnoid hemorrhage with sodium nitroprusside and phenylephrine: an experimental study

The effectiveness of simultaneous intravenous sodium nitroprusside and phenylephrine in improving the cerebrovascular disturbances and survival rate after induced subarachnoid hemorrhage (SAH) was studied in the cynomolgus monkey. We measured regional cerebral blood flow (rCBF) using the intra-arterial xenon-133 clearance technique. In our experimental animal model, SAH was associated with a persistent reduction in rCBF, elevation of cerebrovascular resistance (CVR), cerebral vasospasm for the duration of the study (150 minutes), and poor survival. For animals receiving the treatment regime (administered approximately 25 minutes after the induced SAH), rCBF remained low, CVR was high, and cerebral vasospasm was persistent. Survival in this group was the same as that observed for the untreated animals. Simultaneous administration of sodium nitroprusside and phenylephrine was ineffective in improving rCBF, CVR, cerebral vasospasm, or survival after SAH. In the control group (receiving only the treatment and not an intracranial insult), rCBF was below resting levels both during and after therapy, indicating impaired cerebral autoregulation. (Neurosurgery, 5: 688--595, 1979).