Resolution of Experimental Microvascular Spasm and Improvement in Anastomotic Patency by Direct Topical Agent Application

Geter, Rodney K.; Richard, RB; Winter, Selina; Puckett, Charles L.

doi:10.1097/00006534-198601000-00016

Cited by 45 publications

(52 citation statements)

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“…20 Several authors have also reported that the use of topical epinephrine to induce vasospasm was a convenient and reproducible model. [22][23][24]27 Some authors have used norepinephrine or endothelin-1 to resemble clinical vasospasm. 28,29 They stated that such spasmogenic substances probably play an important role in the vasospasm after skin flap surgery, but most were in vitro studies.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Different Combinations of Microvascular Anastomosis Types in a Rat Vasospasm Model: Versatility of End-to-Side Venous Anastomosis in Free Tissue Transfer for Extremity Reconstruction

Miyamoto

Takushima

Okazaki

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Section: Discussionmentioning

confidence: 99%

Comparative Study of Different Combinations of Microvascular Anastomosis Types in a Rat Vasospasm Model: Versatility of End-to-Side Venous Anastomosis in Free Tissue Transfer for Extremity Reconstruction

Miyamoto

Takushima

Okazaki

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…It inactivates myosin light chain kinase, blocks the phosphorylation of actin and myosin, and decreases smooth muscle contraction (7). The blood flow in the chlorpromazine group seemed to show an earlier initial effect than that in the lidocaine group.…”

Section: Discussionmentioning

confidence: 93%

“…The pattern of action of each drug in a single peripheral artery was studied. Lidocaine is known as a blocking agent for the ion flux in the cell membrane of the nerve and smooth muscle (3,7). This produces relaxation of the smooth muscle of the artery.…”

Section: Discussionmentioning

confidence: 99%

“…Though various physical and pharmacological factors may cause such a spasm, the occurrence is unpredictable (7,11,13), and its management is empirical. It is practically important for surgeons to prevent the development of such spasms.…”

mentioning

confidence: 99%

“…For this reason, various kinds of vasodilators have been used to overcome the phenomenon. Several authors have suggested the use of vasodilators, such as lidocaine 4% (1,3,15) or chlorpromazine applied topically (2,4,7), and prostaglandin E1 (PGE1) (5,12,14) and diltiazem hydrochloride (9) given systemically. Each vasodilator has specific pharmacological effects such as initial action, duration, and peak time, when applied to the anastomosed vessel.…”

mentioning

confidence: 99%

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The Blood Flow Patterns of Microsurgical Procedures in Rats With Topical and Systemic Vasodilators

Notodihardjo

Ogawa

Kusumoto

1998

Scandinavian Journal of Plastic and Reconstructive Surgery and

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The change in blood flow after anastomosis and the effects on the anastomosed artery of different classes of vasodilators such as lidocaine and chlorpromazine given topically (n = 10 in each group), and prostaglandin E1 (PGE1)(n = 12) and diltiazem hydrochloride (n = 10) given systemically, were investigated in the femoral arteries of rats. The blood flow after anastomosis decreased by 45%-60% compared with that before the anastomosis. Lidocaine showed almost the same pattern of blood flow as chlorpromazine. The former dilated the diameter of the vessel less than the latter, and the depression of the heart rate was less with lidocaine than in chlorpromazine. PGE1 had a longer and stronger vasodilatative action than diltiazem, and resulted in a remarkable increase in blood flow. Clinically, the topical application of chlorpromazine or lidocaine is recommended during an operation, and PGE1 should be given systemically after an operation to obtain adequate blood flow.

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Drug-induced vasodilation: In vitro and in vivo study on the effects of lidocaine and papaverine on rabbit carotid artery

et al. 1998

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Flap ischemia is often encountered during pedicled and free tissue transfer. In this study, the vascular effects of varying doses of lidocaine, papaverine, and a combination of the two agents were evaluated and compared in an in vitro and in vivo model in the rabbit carotid artery. In the in vitro study, 14 rings from the rabbit carotid artery were bathed in Krebs-Ringers solution and stretched progressively to an optimal tension of 3.7-4.2 grams. Their isometric contractile activity was measured. The specimens were precontracted with norepinephrine (1 microM), and a dose response curve was established by adding cumulatively either lidocaine (to 7 arterial rings) or papaverine (to 7 arterial rings) at increasing concentrations. In the in vivo study, microvascular anastomoses were performed bilaterally in the rabbit carotid artery in 30 animals using 9-0 nylon suture and standard microsurgical techniques. In each animal, one side was treated with heparinized sodium chloride and served as the control. The other side was treated blindly, during and after the anastomoses, with a topical application of 1 ml of either lidocaine 2% (n = 5), lidocaine 20% (n = 5), papaverine (30 mg/ml, n = 5), lidocaine 2% combined with papaverine (30 mg/ml, n = 5), or lidocaine 20% combined with papaverine (30 mg/ml, n = 5). For 30-60 minutes after the procedure, blood flow changes in the vessels were continuously monitored with a transonic doppler applied to both carotid arteries. The 20% lidocaine group was flushed with saline at the end of the first hour and monitored for an additional 60 minutes. Papaverine elicited a concentration-dependent relaxation of norepinephrine precontracted carotid artery rings in vitro. Lidocaine elicited a biphasic response, with low concentrations (10(-6)-10(-4) M) increasing the norepinephrine-induced contraction and high concentrations (10(-4)-10(-2) M) relieving this contraction. Microsurgical anastomosis produced a significant decrease of blood flow through the rabbit carotid artery as measured by the transonic doppler. Drug application did not alter the systemic blood pressure of the animals. Topical application of lidocaine 2% did not significantly change the blood flow after microvascular anastomosis. Topical application of lidocaine 20%, papaverine (30 mg/ml), or lidocaine (2% or 20%) combined with papaverine significantly increased the blood flow in the rabbit carotid artery. In the lidocaine 20% group, the blood flow remained significantly increased after the drug was flushed with heparinized saline solution. These results demonstrate that topical lidocaine 20%, papaverine, and lidocaine 2% or 20% combined with papaverine significantly increase blood flow in the rabbit carotid artery after microvascular anastomosis. The data confirm the use of papaverine and lidocaine 20%, alone or in combination, as spasmolytics during clinical microsurgery. This suggests that lidocaine 2% alone is not the ideal drug to relieve vascular constriction, and further studies on the clinical use of low concentratio...

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Resolution of Experimental Microvascular Spasm and Improvement in Anastomotic Patency by Direct Topical Agent Application

Cited by 45 publications

References 0 publications

Comparative Study of Different Combinations of Microvascular Anastomosis Types in a Rat Vasospasm Model: Versatility of End-to-Side Venous Anastomosis in Free Tissue Transfer for Extremity Reconstruction

Comparative Study of Different Combinations of Microvascular Anastomosis Types in a Rat Vasospasm Model: Versatility of End-to-Side Venous Anastomosis in Free Tissue Transfer for Extremity Reconstruction

The Blood Flow Patterns of Microsurgical Procedures in Rats With Topical and Systemic Vasodilators

Drug-induced vasodilation: In vitro and in vivo study on the effects of lidocaine and papaverine on rabbit carotid artery

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