The Use of Topical Vasodilators as an Adjunct in Infant Renal Surgery

Abstract

In infant renal surgery there is a well recognized problem with vasospasm and resultant renal ischemia. Recently, we applied vasodilators to the perivascular tissues during renal surgery to prevent vasospasm. With this mode of treatment no renal units were lost owing to ischemia secondary to the operative procedure. The treatment has been especially useful in infants with duplicated systems undergoing partial nephroureterectomy. Owing to the diminutive size of infant renal vessels, vasospasm can be triggered easily even with the most careful hilar dissection. Thus, to assure maximal preservation of tissue, vasospasm must be prevented before renal mobilization and hilar dissection. Therefore, to prevent the development of renal ischemia in infants undergoing renal surgery we recommend initial exposure of the hilar vessels before dissection, application of papaverine and lidocaine to the perivascular tissues, and delaying further dissection until maximal vasodilation has occurred.

Facial Nerve Palsy After Intracisternal Papaverine Application During Aneurysm Surgery

“…8,20) Topical papaverine is also used in non-neurosurgical operations in which vessel manipulation may induce vascular spasm, such as infant renal surgery. 7) Transient ipsilateral pupillary dilation (mydriasis) with pupillary areflexia after intracisternal and intraarterial papaverine application is a common benign side effect. 3,10,15,21) Papaverine is commonly used today and this mydriatic effect is well known so this is no longer reported.…”

Catheter-induced brachial artery thrombosis in the neonate

“…Important risk factors for the development of thrombosis include inflammation, maternal diabetes, disseminated intravascular coagulation, congenital heart disease, decreased cardiac output, neonatal polycythemia, and sepsis [4,5]. polycythemia, and greater propensity for vasospasm of vessels [6][7][8]. Photograph of the hand immediately postoperative.…”

Severe bronchospasm relieved by papaverine?

“…After retrieval, the donor kidney had been perfused with a hypertonic citrate solution. Just before release of the renal arterial clamp, papaverine 10 mg was injected into the iliac artery to prevent vasospasm of the anastomosed vessels [1]. The subsequent sequence of events suggests the intra‐arterial papaverine reversed the severe bronchospasm.…”