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Change in estimated cerebral perfusion pressure after treatment with nimodipine or magnesium sulfate in patients with preeclampsia.
Am J Obstet Gynecol. 1999 Aug; 181(2):402-7.AJ

Abstract

OBJECTIVE

Data are accumulating to suggest that cerebral perfusion pressure may be either abnormally high or low in preeclampsia and eclampsia. Little is known of the cerebral perfusion pressure effects of magnesium sulfate or nimodipine. Our objective in this study was to compare the change in cerebral perfusion pressure in patients with severe preeclampsia randomly selected to receive nimodipine or magnesium sulfate.

STUDY DESIGN

Patients with severe preeclampsia were randomly selected to receive magnesium sulfate (6 g bolus and 2 g/hr intravenous infusion) or nimodipine (60 mg taken orally every 4 hours). Transcranial Doppler ultrasonography was used to measure flow velocities in the right and left middle cerebral arteries, and the results were averaged. Measurements were obtained before treatment (baseline) and 30 minutes after the magnesium sulfate bolus was completely infused or 30 minutes after the nimodipine was ingested. Studies were performed before any other intervention. The person performing the ultrasonography was unaware of the patient's group assignment. Estimated cerebral perfusion pressure was calculated with the following formula: Estimated cerebral perfusion pressure = Velocity(mean) x [(Blood pressure(mean) - Blood pressure(diastolic))/(Velocity(mean) - Velocity(diastolic))]. The difference between estimated cerebral perfusion pressure at baseline and after treatment was compared between the 2 groups by means of the Mann-Whitney rank sum test.

RESULTS

Nine patients were randomly selected to receive nimodipine and 12 to receive magnesium sulfate. Patient demographics and severity of condition were not significantly different between the 2 groups. The change in estimated cerebral perfusion pressure was significantly different between the groups. Estimated cerebral perfusion pressure increased after nimodipine use and decreased after magnesium sulfate use.

CONCLUSION

Shortly after administration to patients with severe preeclampsia, nimodipine resulted in increased cerebral perfusion pressure in comparison with magnesium sulfate.

Authors+Show Affiliations

Belfort MA
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City Utah, USA.
Saade GR
No affiliation info available
Yared M
No affiliation info available
Grunewald C
No affiliation info available
Herd JA
No affiliation info available
Varner MA
No affiliation info available
Nisell H
No affiliation info available

MeSH

AdultBlood Flow VelocityBlood PressureCalcium Channel BlockersCerebral ArteriesFemaleHumansMagnesium SulfateNimodipinePre-EclampsiaPregnancyUltrasonographyVasodilator Agents

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

10454691

Clinical Trial Links

Labetalol Versus Magnesium Sulfate (MgSO4) for the Prevention of Eclampsia Trial

Citation

Belfort, M A., et al. "Change in Estimated Cerebral Perfusion Pressure After Treatment With Nimodipine or Magnesium Sulfate in Patients With Preeclampsia." American Journal of Obstetrics and Gynecology, vol. 181, no. 2, 1999, pp. 402-7.
Belfort MA, Saade GR, Yared M, et al. Change in estimated cerebral perfusion pressure after treatment with nimodipine or magnesium sulfate in patients with preeclampsia. Am J Obstet Gynecol. 1999;181(2):402-7.
Belfort, M. A., Saade, G. R., Yared, M., Grunewald, C., Herd, J. A., Varner, M. A., & Nisell, H. (1999). Change in estimated cerebral perfusion pressure after treatment with nimodipine or magnesium sulfate in patients with preeclampsia. American Journal of Obstetrics and Gynecology, 181(2), 402-7.
Belfort MA, et al. Change in Estimated Cerebral Perfusion Pressure After Treatment With Nimodipine or Magnesium Sulfate in Patients With Preeclampsia. Am J Obstet Gynecol. 1999;181(2):402-7. PubMed PMID: 10454691.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Change in estimated cerebral perfusion pressure after treatment with nimodipine or magnesium sulfate in patients with preeclampsia. AU - Belfort,M A, AU - Saade,G R, AU - Yared,M, AU - Grunewald,C, AU - Herd,J A, AU - Varner,M A, AU - Nisell,H, PY - 1999/8/24/pubmed PY - 1999/8/24/medline PY - 1999/8/24/entrez SP - 402 EP - 7 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 181 IS - 2 N2 - OBJECTIVE: Data are accumulating to suggest that cerebral perfusion pressure may be either abnormally high or low in preeclampsia and eclampsia. Little is known of the cerebral perfusion pressure effects of magnesium sulfate or nimodipine. Our objective in this study was to compare the change in cerebral perfusion pressure in patients with severe preeclampsia randomly selected to receive nimodipine or magnesium sulfate. STUDY DESIGN: Patients with severe preeclampsia were randomly selected to receive magnesium sulfate (6 g bolus and 2 g/hr intravenous infusion) or nimodipine (60 mg taken orally every 4 hours). Transcranial Doppler ultrasonography was used to measure flow velocities in the right and left middle cerebral arteries, and the results were averaged. Measurements were obtained before treatment (baseline) and 30 minutes after the magnesium sulfate bolus was completely infused or 30 minutes after the nimodipine was ingested. Studies were performed before any other intervention. The person performing the ultrasonography was unaware of the patient's group assignment. Estimated cerebral perfusion pressure was calculated with the following formula: Estimated cerebral perfusion pressure = Velocity(mean) x [(Blood pressure(mean) - Blood pressure(diastolic))/(Velocity(mean) - Velocity(diastolic))]. The difference between estimated cerebral perfusion pressure at baseline and after treatment was compared between the 2 groups by means of the Mann-Whitney rank sum test. RESULTS: Nine patients were randomly selected to receive nimodipine and 12 to receive magnesium sulfate. Patient demographics and severity of condition were not significantly different between the 2 groups. The change in estimated cerebral perfusion pressure was significantly different between the groups. Estimated cerebral perfusion pressure increased after nimodipine use and decreased after magnesium sulfate use. CONCLUSION: Shortly after administration to patients with severe preeclampsia, nimodipine resulted in increased cerebral perfusion pressure in comparison with magnesium sulfate. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/10454691/Change_in_estimated_cerebral_perfusion_pressure_after_treatment_with_nimodipine_or_magnesium_sulfate_in_patients_with_preeclampsia_ DB - PRIME DP - Unbound Medicine ER -