Three Interesting Case Reports of Intracranial Aneurysm Managed with Triple 'H' Therapy.

Anaesthesia for aneurysm surgeries is highly specialized and unique. Vasospasm is the most important determinant for morbidity and mortality in intracranial aneurysms. For prevention and management of vasospasm Triple-H therapy (Hypertension, Hypervolemia and Haemodilution) is recommended. Triple-H therapy is gold standard in neuroanaesthesia in intracranial aneurysm surgeries in order to increase cerebral blood flow in areas affected by vasospasm and avoid damage caused by ischemia. First patient was 52 years old female with Right vertebral artery posterior inferior cerebellar artery aneurysm of size 1cm, operated successfully who became unconscious 22 hours after surgery and treated with Triple-H therapy for vasospasm. Second case was 48 years old male patient of right anterior cerebral artery aneurysm of 9mm size operated successfully after intraoperative rupture of aneurysm and subsequent vasospasm. Third case was 35 years pregnant female patient of anterior communicating artery aneurysm of 5mm size treated with triple H therapy for vasospasm.

Triple-H Therapy for Cerebral Vasospasm Following Spontaneous Subarachnoid Hemorrhage / 国际脑血管病杂志

Cerebral vasospasm is the leading cause of disability and death in patients with spontaneous subarachnoid hemorrhage,and there is no definitive and effective treatment for it yet.Triple-H therapy is now the first choice in the treatment of cerebral vasospasm,but there are still more controversies about it. In recent years,there have been a number of studies about Triple-H therapy. This article reviews the implementation of Triple-H therapy,fluid selection,and prophylactic application.

Molecular mechanisms of Triple H therapy in the treatment of SAH-induced vasospasm / 第三军医大学学报

Objective Cerebral artery vasospasm is a major cause of death and disability in patients experiencing subarachnoid hemorrhage (SAH). Vasospasm typically has been evaluated using angiography to examine narrowing of large diameter (>1 mm) cerebral arteries. Currently, little is known regarding the impact of SAH on small diameter (100～200 μm) cerebral arteries, which play an important role in the autoregulation of cerebral blood flow. The goal of the current study was to examine the influence of SAH on the pressure-diameter relationship of these small diameter blood vessels. Methods Small diameter cerebral arteries were obtained from a rabbit SAH model. Isolated artery segments were canulated and placed in a myograph chamber superfused with warmed, oxygenated, physiological saline solution. Diameter measurements were then recorded to step-wise increases in intravascular pressure. Results Cerebral arteries from SAH animals exhibited a significant increase in pressure-induced constrictions (myogenic tone) at intravascular pressures between 40 mmHg and 120 mmHg. At intravascular pressures above 120 mmHg, myogenic tone began to decrease and was abolished at pressures above 180 mmHg. Conclusion These data suggest that in the days following SAH, myogenic tone is enhanced in small diameter cerebral arteries subjected to physiological levels of intravascular pressure. However, supra-physiological intravascular pressures causes vasodilation, suggesting small diameter cerebral arteries may act as therapeutic targets of hypervolemia, hemodilution, and hypertension "Triple H therapy" used in the treatment of cerebral artery vasospasm.

Molecular mechanisms of Triple H therapy in the treatment of SAH-induced vasospasm / 第三军医大学学报

Objective Cerebral artery vasospasm is a major cause of death and disability in patients experiencing subarachnoid hemorrhage (SAH). Vasospasm typically has been evaluated using angiography to examine narrowing of large diameter (>1 mm) cerebral arteries. Currently, little is known regarding the impact of SAH on small diameter (100～200 μm) cerebral arteries, which play an important role in the autoregulation of cerebral blood flow. The goal of the current study was to examine the influence of SAH on the pressure-diameter relationship of these small diameter blood vessels. Methods Small diameter cerebral arteries were obtained from a rabbit SAH model. Isolated artery segments were canulated and placed in a myograph chamber superfused with warmed, oxygenated, physiological saline solution. Diameter measurements were then recorded to step-wise increases in intravascular pressure. Results Cerebral arteries from SAH animals exhibited a significant increase in pressure-induced constrictions (myogenic tone) at intravascular pressures between 40 mmHg and 120 mmHg. At intravascular pressures above 120 mmHg, myogenic tone began to decrease and was abolished at pressures above 180 mmHg. Conclusion These data suggest that in the days following SAH, myogenic tone is enhanced in small diameter cerebral arteries subjected to physiological levels of intravascular pressure. However, supra-physiological intravascular pressures causes vasodilation, suggesting small diameter cerebral arteries may act as therapeutic targets of hypervolemia, hemodilution, and hypertension "Triple H therapy" used in the treatment of cerebral artery vasospasm.

Molecular mechanisms of Triple H therapy in the treatment of SAH-induced vasospasm / 第三军医大学学报

Objective Cerebral artery vasospasm is a major cause of death and disability in patients experiencing subarachnoid hemorrhage (SAH). Vasospasm typically has been evaluated using angiography to examine narrowing of large diameter (>1 mm) cerebral arteries. Currently, little is known regarding the impact of SAH on small diameter (100～200 μm) cerebral arteries, which play an important role in the autoregulation of cerebral blood flow. The goal of the current study was to examine the influence of SAH on the pressure-diameter relationship of these small diameter blood vessels. Methods Small diameter cerebral arteries were obtained from a rabbit SAH model. Isolated artery segments were canulated and placed in a myograph chamber superfused with warmed, oxygenated, physiological saline solution. Diameter measurements were then recorded to step-wise increases in intravascular pressure. Results Cerebral arteries from SAH animals exhibited a significant increase in pressure-induced constrictions (myogenic tone) at intravascular pressures between 40 mmHg and 120 mmHg. At intravascular pressures above 120 mmHg, myogenic tone began to decrease and was abolished at pressures above 180 mmHg. Conclusion These data suggest that in the days following SAH, myogenic tone is enhanced in small diameter cerebral arteries subjected to physiological levels of intravascular pressure. However, supra-physiological intravascular pressures causes vasodilation, suggesting small diameter cerebral arteries may act as therapeutic targets of hypervolemia, hemodilution, and hypertension "Triple H therapy" used in the treatment of cerebral artery vasospasm.