Cardiac arrest after intracisternal papaverine instillation during intracranial aneurysm surgery

Baltaci, Bülent; Başar, Hülya; Özcan, Ayşe; Gulhan, Y.; Aytünür, Cihan Sedat

doi:10.3171/2009.11.jns09899

Cited by 14 publications

(13 citation statements)

References 11 publications

(18 reference statements)

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“…Hemodynamic and metabolic adverse effects were reported in a total of 15 cases. These effects included profound hypotension (5,20,22), bradycardia (5), both hypotension and bradycardia (14,16,23), and hypertension and tachycardia (17). Two of the three reported cases of intracisternal papaverine complications in the form of both hypotension and bradycardia progressed to cardiac arrest and death (16,23); these were the only reported deaths related to cisternal papaverine.…”

Section: Resultsmentioning

confidence: 99%

“…Our search yielded 19 articles, with a total of 43 aneurysms. As for the types of articles; there were two original articles (5,6), two case reports and reviews (7,8), one case series (9), nine case reports (10)(11)(12)(13)(14)(15)(16)(17)(18), and five letters to the editor (19)(20)(21)(22)(23). The two most common aneurysm locations that were associated with topical papaverine complications were the middle cerebral artery (MCA) and the anterior communicating artery (AcomA) with 18 and 17 cases, respectively.…”

Section: Resultsmentioning

confidence: 99%

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Intracisternal papaverine toxicity in anterior circulation aneurysm clipping surgery

Al-Sharshahi¹,

Hoz²,

Almurayati³

et al. 2020

roneuro

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Introduction. Cerebral vasospasm is a major cause of mortality in patients with subarachnoid haemorrhage. Irrigation of intracisternal papaverine has been adopted as a strategy to reduce the incidence of aneurysm-surgery-associated vasospasm. Aim. The aim of this literature review is to summarize the reported complications associated with intracisternal papaverine administration. Patients and Methods. We searched the following databases: PubMed, Google Scholar, Cochrane Library, Clinical Key, Embase, Emerald, Health Business Elite, MEDLINE at OVID, EBM Reviews and Research Gate. The following keywords were used: Intracisternal papaverine, topical papaverine, direct papaverine, a vasodilator for aneurysm surgery, papaverine in aneurysm clipping, papaverine complications and papaverine side effects. The search criteria included all articles published between 1980-2019, in the English language. Results. Our search yielded a total of 19 articles describing 43 cases. The most common reported complication was ipsilateral oculomotor nerve palsy. Other local complications included: Bilateral oculomotor nerve palsy, ipsilateral facial nerve palsy, and monocular blindness. Although less common, reports pointing to papaverine systemic toxicity did exist. Examples of such complications included: Profound hypotension, bradycardia, hypertension and tachycardia, hyperthermia and metabolic acidosis, cardiac arrest and even death. Conclusion. Intracisternal papaverine irrigation is an effective strategy in reducing peri-operative vasospasm associated with aneurysm surgery. Although uncommon, both local and systemic side effects have been linked to papaverine use, calling for careful dosing and close monitoring to enhance its safety profile.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Intracisternal papaverine toxicity in anterior circulation aneurysm clipping surgery

Al-Sharshahi¹,

Hoz²,

Almurayati³

et al. 2020

roneuro

View full text Add to dashboard Cite

show abstract

“…For hypervolemia the target is euvolemia or very slight hypervolemia the most used agents: colloid: albumin, low molecular weight dextran, keep systolic blood pressure (SBP) between 160~180mmHg in all cases pre and postoperative. During operation, in case swelling of the brain, to avoid excessive brain retraction, surgical exposure requires sufficient bony removal, we use hyperventilation, CSF drainage(ventriculostomy, lumbar spinal drainage and intra-operative drainage) and diuretics mannitol with Decadron, furosemide and continuous irrigation of the operation field with normal saline (NS), nimotop can have some effect on vasospasmic vessels,we do not use papaverine because its side effects like hypotension ,bradycardia and even death [27] [28].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with outcomes in ruptured aneurysmal patients: Clinical Study of 80 Patients

Alfotih¹,

Li²,

Xu³

et al. 2015

Romanian Neurosurgery

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Background: Due to insufficient data in the literature, the optimal timing for surgical intervention for ruptured intracranial aneurysms is still controversial. Some practitioners advocate early surgery, but others not. It is important to identify other factors that can be used to predict poor prognosis in ruptured intracranial aneurysm patients. Objective: To determine the influence of timing of clipping surgery, and other factors on the outcomes of ruptured intracranial aneurysms in Hunt & Hess I~III grade patients. Method: We have performed a retrospective study involving 80 patients who were surgically treated for ruptured intracranial aneurysm between 2007 and 2012. The patient population consisted of 50(62.5%) females and 30(37.5%) males, with an age range of 12 to 75 years old, mean age 52.33 ± 10.63 years. We measured association between the Glasgow Outcome Scores and Sex, timing of clipping surgery, aneurysm location and pre-operative patient's neurological condition using famous Hunt and Hess grade system. Results: We did not find any correlation between the outcomes of ruptured intracranial aneurysm patients and timing (early, intermediate, late stage) of clipping, sex, aneurysm location. Whereas there is a significant correlation between patients outcomes and pre-operative patient neurological condition (Hunt & Hess grade). Conclusion: Timing of Surgery (early, intermediate, late) does not affect outcomes in low Hunt and Hess grade patients I~III. Whereas neurological condition (Hunt & Hess) has strong impact on postoperative outcomes. Others factors like sex, Age, Aneurysm location have no effect on outcomes in ruptured intracranial aneurysms.

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“…Locally applied papaverine, which has been used for the prevention of cerebral vasospasm, has also been implicated in fatal cardiac arrest [ 48 ]. This was thought to be due to stimulation of the hypothalamus or vagal nucleus, or with brainstem depression, although the exact mechanism was not known.…”

Section: Causes and Mechanisms Of Cardiac Emergenciesmentioning

confidence: 99%

Cardiac Emergencies in Neurosurgical Patients

Chowdhury

Petropolis

Cappellani

2015

BioMed Research International

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Perioperative safety concerns are a major area of interest in recent years. Severe cardiac perturbation such as cardiac arrest is one of the most dreaded complications in the intraoperative period; however, little is known about the management of these events in the patients undergoing elective neurosurgery. This special group needs further attention, as it is often neither feasible nor appropriate to apply conventional advanced cardiac life support algorithms in patients undergoing neurosurgery. Factors such as neurosurgical procedure and positioning can also have a significant effect on the occurrence of cardiac arrest. Therefore, the aim of this paper is to describe the various causes and management of cardiac emergencies with special reference to cardiac arrest during elective neurosurgical procedures, including discussion of position-related factors and resuscitative considerations in these situations. This will help to formulate possible guidelines for management of such events.

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Cardiac arrest after intracisternal papaverine instillation during intracranial aneurysm surgery

Cited by 14 publications

References 11 publications

Intracisternal papaverine toxicity in anterior circulation aneurysm clipping surgery

Intracisternal papaverine toxicity in anterior circulation aneurysm clipping surgery

Factors associated with outcomes in ruptured aneurysmal patients: Clinical Study of 80 Patients

Cardiac Emergencies in Neurosurgical Patients

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