All patients with acute aneurysmal hemorrhage are treated in accordance with our institutional protocol. After securing of the aneurysm, some smokers with acute aneurysmal hemorrhage are randomly assigned to transdermal nicotine replacement (NRT). The short- and long-term effect of NRT will be studied comparing non-smokers, smokers without NRT and smokers with NRT.
Various aspects of the study: * Study cerebral circulation with transcranial Doppler ultrasonography (TCD) prior to and after NRT. * Study cardiac output and peripheral vessel resistance minimally invasive (LiDCO) prior to and after NRT in patients that already have established LiDCO. * Monitor intracranial pressure prior to and after NRT in patients that have established an intracranial pressure sensor. * Register the frequency of cerebral vasospasm and complications in non-smokers, smokers without NRT, and smokers with NRT. * Register the use of opioids, opioidanesthetics, propofol og psycholeptics in non-smokers, smokers without NRT, and smokers with NRT.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
200
Application of transdermal nicotine replacement in smokers with acute aneurysmal hemorrhage
Oslo University Hospital
Oslo, Oslo, Norway
Cerebral vasospasm
Frequency of cerebral vasospasm within 21 days after the ictus. The institutional protocol for management of aneurysmal hemorrhage is followed in diagnosing cerebral vasospasm. This includes monitoring for cerebral vasospasm with transcranial Doppler ultrasonography and a cerebral computed tomography angiogram on day 7 after the ictus. Digital subtraction angiography is performed when necessary. All patients are monitored in the intensive care or intermediate care unit for clinical signs of cerebral vasospasm.
Time frame: 21 days
Smoking status
Managed to quit smoking after NRT?
Time frame: 1 year
Functional outcome
Glasgow outcome scale, Glasgow outcome scale extended, Rankin Stroke Scale, return to work
Time frame: 3 and 12 months
Drug consumption
Use of sedatives and anesthetics
Time frame: as long as the patient is in the intensive care unit
Cerebral infarction
Radiological evidence of irreversible brain tissue damage. All patients have a control scan approximately 3 months after the ictus. This is either a computed tomography scan (if the patient had the aneurysm secured surgically) or a magnetic resonance image (if the patient had endovascular repair of the aneurysm)
Time frame: 3-6 months
Complications
Frequency of complications including secondary hydrocephalus and mortality. Special emphasis on thrombo-embolic complications (deep venous thrombosis and pulmonary embolism)
Time frame: 3-6 months
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.