Anesthesia, Local, Cerebral Vasospasm, Subarachnoid Hemorrhage, Aneurysmal
Conditions
Keywords
regional anesthesia, cervical sympathectomy, cerebral blood flow
Brief summary
The purposes of this study are twofold: 1) to assess the effect of a cervical sympathetic block on cerebral blood flow in patients suffering from cerebral vasospasm, after aneurysmal subarachnoid hemorrhage; 2) to evaluate the effect of the sympathetic block on the recovery of the neurological function.
Detailed description
Patients hospitalized in the intensive care unit (ICU) and developing clinical manifestations of cerebral vasospasm will be transferred to the neuro-interventional radiology suite for vasospasm treatment. After the vasospasm is confirmed by the angiography followed by a flat panel-computed tomography perfusion (FP-CTP) scan, a cervical sympathetic nerve block under ultrasound guidance will be performed. The block consists of the deposition of local anesthetic at the cervical sympathetic ganglion that will be visualized with an ultrasound device. The local anesthetic solution with be mixed with a radiographic contrast agent to check the spread of the injectate in the desired anatomical location. The spread of the local anesthetic will be assessed by performing an 8-second head/neck C-arm CT scan. Following the block, another run of angiography and a second FP-CTP will be repeated to assess changes in vessels diameter and in perfusion parameters following the sympathetic block. Patients will have a daily monitoring of their neurological function and of their cerebral blood flow with transcranial doppler in the ICU. At 12 months post-aSAH, the patients will complete neurological and neuropsychological assessments as a part of the standard of care. The results of these tests will be collected for analysis.
Interventions
PROCEDURECervical sympathetic block
All participants will get the cervical sympathetic block and catheter under ultrasound guidance.
Sponsors
Stanford University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ages 18 and over * patients hospitalized in the ICU and developing cerebral vasospasm after aneurysmal subarachnoid hemorrhage
Exclusion criteria
\- known advanced stage kidney disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cerebral blood flow | 1 hour after the block | Cerebral blood flow as measured by computed tomography perfusion |
| Neurological function | Duration of recovery in ICU (1-2 weeks) | Change in neurological status as assessed by the Glasgow Coma Scale. The Glasgow Coma Scale score can range from 3 (completely unresponsive) to 15 (responsive). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Executive Functioning - Wisconsin Card Sorting Test (WCST) | 12 months post-aSAH | Measures executive functioning, including cognitive flexibility and problem-solving. The number of categories completed and total errors will be converted to age-adjusted z-scores. Favorable outcome: z-score ≥ -1.0, unfavorable outcome: z-score \< -1.0 (indicative of cognitive impairment in executive functioning). |
| Language - Boston Naming Test (BNT) | 12 months post-aSAH | Evaluates confrontational word retrieval and naming ability. Scores are standardized using age norms. Favorable outcome: z-score ≥ -1.0, unfavorable outcome: z-score \< -1.0 |
| Verbal Fluency - FAS Test | 12 months post-aSAH | Tests lexical fluency by asking participants to generate words beginning with F, A, and S in a set time period. Z-scores are calculated from age-adjusted norms. Favorable outcome: z-score ≥ -1.0, unfavorable outcome: z-score \< -1.0 |
| Processing Speed - Symbol Digit Modalities Test (SDMT) | 12 months post-aSAH | Assesses visual scanning, tracking, and motor speed. Raw scores are adjusted for age and converted to z-scores. Favorable outcome: z-score ≥ -1.0, unfavorable outcome: z-score \< -1.0 |
| General mental status - Montreal Cognitive Assessment (MoCA) | 12 months post-aSAH | Screens for mild cognitive impairment across multiple cognitive domains. Raw scores range from 0 to 30. Favorable outcome: MoCA score ≥ 26, unfavorable outcome: MoCA score \< 26 (suggestive of cognitive impairment). |
| Functional disability - modified Rankin scale (mRS) | 12 months post-aSAH | Measurement of functional disability using mRS, categorized as favorable (0-3) or unfavorable (4-6), to assess long-term disability and its association with baseline perfusion. |
| Health-Related Quality of Life (HRQoL, SF-36) | 12 months post-aSAH | HRQoL will be reported as standardized z-scores, with higher scores indicating better performance. |
| Memory - Hopkins Verbal Learning Test-Revised (HVLT-R) | 12 months post-aSAH | Assesses verbal learning and memory, including immediate recall, delayed recall, and recognition. Performance is normed and converted into z-scores. Favorable outcome: z-score ≥ -1.0, unfavorable outcome: z-score \< -1.0 |
| Cerebral blood flow velocity | Daily during recovery in ICU (1-2 weeks) | Transcranial doppler measurement |
Countries
United States
Outcome results
None listed