Hemodynamic Stability After Intraarterial Injection of Verapamil for Cerebral Vasospasm Anesthesia & Analgesia, 05/31/2012

Flexman AM et al. – Under general anesthesia, injection of IA verapamil into cerebral arteries reduces mean arterial blood pressure but does not change HR in the average patient.

• The authors prospectively studied subjects with vasospasm scheduled for cerebral angiography with possible IA injection of verapamil.
• All subjects were given a general anesthetic.
• After 3 months of experimental interventions the effects of the treatments on the body and uterine weights, the physical and biomechanical properties of bones, and the expression of the osteoblast–specific gene Osterix (Osx), were assessed.
• Invasive arterial blood pressure and HR were monitored continuously and recorded at 10–second intervals throughout the procedure.
• The authors identified the lowest MAP and highest HR before and after verapamil injection.
• The association between IA verapamil and change in MAP and HR was determined using repeated–measures multivariate regression analysis, adjusting for potential confounding factors (weight, preoperative vasopressor use, and preinjection MAP).
• Data are reported as adjusted coefficients and 95% confidence intervals (CI).

• The authors included 20 subjects who underwent a total of 46 injections of IA verapamil.
• On the basis of the multivariate model, on average, each 5 mg of IA verapamil was associated with a 3.5 mm Hg reduction in MAP (95% CI –5.0 to –2.0, P < 0.001).
• HR was not significantly altered by IA verapamil on both unadjusted and adjusted analyses (nonsignificant increase of 0.4 beats per minute for each 5 mg of IA verapamil, 95% CI –1.6 to 2.4, P = 0.70).