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Haemodynamic changes after intracisternal papaverine instillation during intracranial aneurysmal surgery.

Abstract
Cerebral vasospasm remains a significant cause of mortality and morbidity after aneurysmal subarachnoid haemorrhage. Use of either intra-arterial or intracisternal papaverine as an alternative treatment of refractory cerebral vasospasm has been associated with various complications including haemodynamic instabilities. However, our search in literature did not reveal association of bradycardia and hypotension with the use of papaverine by either of these routes. Here, we describe a case of anterior communicating artery aneurysm with hydrocephalus. The patient underwent craniotomy and clipping of the aneurysm followed by third ventriculostomy. Instillation of papaverine at the surgical site caused significant haemodynamic changes possibly because of stimulation of hypothalamus in the third ventricle or vagal nuclei in the fourth ventricle, or even both. We recommend cautious use of intracisternal papaverine in such scenario especially when third ventriculostomy has been performed as an adjunct surgical procedure.
AuthorsG P Rath, Mukta, H Prabhakar, H H Dash, A Suri
JournalBritish journal of anaesthesia (Br J Anaesth) Vol. 97 Issue 6 Pg. 848-50 (Dec 2006) ISSN: 0007-0912 [Print] England
PMID16984954 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Vasodilator Agents
  • Papaverine
Topics
  • Administration, Topical
  • Bradycardia (chemically induced)
  • Humans
  • Hypotension (chemically induced)
  • Intracranial Aneurysm (surgery)
  • Intraoperative Complications (chemically induced)
  • Male
  • Middle Aged
  • Papaverine (adverse effects)
  • Vasodilator Agents (adverse effects)
  • Vasospasm, Intracranial (prevention & control)
  • Ventriculostomy

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