Haemodynamic effects of intravenous nimodipine following aneurysmal subarachnoid haemorrhage: implications for monitoring.

Nimodipine is widely used in patients with aneurysmal subarachnoid haemorrhage for the prevention and treatment of delayed ischaemic neurological deficits. Intravenous nimodipine has significant vasodilatory properties and may compromise the achievement of haemodynamic targets in patients who receive hypertensive hypervolaemic haemodilution therapy. We have studied 22 patients who received postoperative therapy with intravenous nimodipine and show that in a substantial minority (29%) hypotension was not reversed by simple volume loading or low doses of inotropes. Formal haemodynamic assessment in these patients showed widely varying haemodynamic variables, with differences in the need for inotropic and vasopressor therapy. We conclude that optimal haemodynamic management in this subgroup of patients will require the use of pulmonary artery catheterisation.