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Hyperbaric oxygen combined with nicardipine administration accelerates neurologic recovery after cerebral ischemia in
N Iwatsuki1, M Takahashi, K Ono
1Department of Anesthesiology, Tohoku University School of Medicine, Sendai, Japan.
Objective:
To evaluate the efficacy of combined therapy--hyperbaric oxygenation with nicardipine administration--for neurologic recovery after complete cerebral ischemia.
Design:
Randomized, prospective, controlled, unblinded, study, with 14-day postischemic observation.
Setting:
Laboratory of the Department of Anesthesiology, Tohoku University School of Medicine.
Subjects:
Nineteen healthy mongrel dogs (mean weight 10.4 kg) divided randomly into two groups-ten dogs in the untreated group and nine dogs in the treated group.
Interventions:
Fifteen minutes of complete global cerebral ischemia was achieved by occlusion of the ascending aorta and the caval veins. Dogs in the treated group each received a 0.01-mg/kg bolus injection of nicardipine immediately after the reestablishment of circulation, followed by a 0.03-microgram/kg/min continuous infusion of nicardipine for 3 days and hyperbaric oxygen therapy with 3 atmospheres absolute pressures in an FIO2 of 1.0 for 1 hr at 3, 24, and 29 hrs after ischemia. Neurologic recovery was evaluated based on the survival time and rate, the Electroencephalogram (EEG) Score (1 = normal, 5 = isoelectric), and the Neurologic Recovery Score (100 = normal, 0 = brain dead) over a 14-day postischemic period.
Measurements And Main Results:
Neurologic Recovery Scores of the treated group were always higher than those scores of the untreated group throughout the 14-day period. The best Neurologic Recovery Score was 83.1 +/- 5.3 in the treated group and 46.9 +/- 5.2 in the untreated group (p < .01). The numbers of dogs that recovered to a Neurologic Recovery Score of > 85 (assessed as almost normal) was five of nine in the treated group and none of ten in the untreated group (p < .01). Recovery of EEG over 14-day period was better in the treated group. The survival rate and the predicted survival rate were 78% and 13.6 days in the treated group and 30% and 9.0 days in the untreated group, respectively (p < .04 for the survival rate and p < .05 for the survival time).
Conclusion:
Combined therapy, using hyperbaric oxygenation with nicardipine administration, given after 15 mins of complete global cerebral ischemia, accelerates neurologic recovery in dogs.