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Background  In patients with subarachnoid hemorrhage (SAH), vasospasm remains one of the major complications. The application of intravenous magnesium sulfate (MgSO 4 ) has been under discussion to prevent cerebral ischemia. Our aim was to examine the impact of early MgSO 4  administration on local cerebral microcirculation during microsurgical clipping of SAH-related aneurysms.    Methods  The non-invasive laser-Doppler spectrophotometry system “Oxygen-to-See (O2C)” was used in 14 consecutive patients (11 female, 3 male, median age 56.5±9.7 yrs) with aneurysmatic SAH. A subdural probe measured capillary venous oxygenation (SO2), relative hemoglobin content (rHb), blood cell velocity (velo) and blood flow (flow) in 7 mm tissue depth. Data samples were recorded as baseline immediately before intraoperative application of MgSO 4  10% 50 mg/kg body weight and 10 min thereafter. The continuous MgSO 4  infusion rate depended on blood pressure (mean arterial pressure > 60-65 mmHg) and lasted a maximum of 60 min.    Results  MgSO 4  was administered 2.8 (min. 1.6, max. 15.5) hours after onset of symptoms. Median flow increased significantly by 20.8% (5–68%,  p  = 0.001). Velo increased 4.9% (1–17%), rHb decreased 1.5% (3–34%) and SO2 decreased 9.4% (8–38%) by trend compared to the baseline values. FiO 2  correlated positively with velo (r s  = 0.712,  p  = 0.004), whereas arterial HCO 3  correlated negatively with SO2 (r s  = −0.599,  p  = 0.024). Of 14 patients, 2 had symptomatic vasospasm.    Conclusions  Our data suggest an increased cerebral blood flow after early intraoperative administration of MgSO 4  in patients with SAH. Using a non-invasive laser-Doppler spectrophotometry system, this technique is feasible for continuous real-time monitoring of cerebral microcirculation.    Trial registration  DRKS (German Clinical Trial Registry),  DRKS00013047 , retrospectively registered on September 21 st , 2017.

bmc anesthesiology

Intraoperative continuous cerebral microcirculation measurement in patients with aneurysmal subarachnoid hemorrhage: preliminary data on the early administration of magnesium sulfate