title: Embolic activity subsequent to injection of the internal mammary artery with papaverine hydrochloride.
abstract: BACKGROUND
  Neurologic injury is a rare yet devastating outcome of coronary artery bypass grafting surgery. Mechanisms producing both focal and global neurologic injuries include embolization, cerebral hypoperfusion, and hypotension. In this present study, we report an association between variations in the treatment of the internal mammary artery with the detection of cerebral embolic signals.
  
  
  METHODS
  An intensive intraoperative neurologic and physiologic monitoring approach was implemented to associate discrete processes of clinical care with the concurrent detection of cerebral embolic signals, cerebral hypoperfusion, and hypotension. The method of treating the left internal mammary artery was tracked among 68 patients undergoing isolated coronary artery bypass grafting. Cerebral embolic signals were counted within 3 minutes of the treatment of the left internal mammary artery.
  
  
  RESULTS
  Among a series of 68 patients undergoing isolated coronary artery bypass grafting, 22 were not treated with papaverine. Of those treated, 12 received injection intraluminally and 28 had a topical application. Embolic signals were noted concurrently among 7 patients receiving injection of papaverine. No embolic signals were noted among patients who were treated topically.
  
  
  CONCLUSIONS
  We report an association between the injection of papaverine hydrochloride and cerebral embolic signals. Our findings suggest that adoption of topical applications of papaverine hydrochloride may offer opportunities to reduce a portion of cerebral embolic signals in the setting of coronary artery bypass grafting.
authors.affiliation: Department of Surgery and Community & Family Medicine and Medicine, Dartmouth Medical School, Hanover, NH 03756, USA. Donald.Likosky@Dartmouth.edu
authors.forename: Donald S
authors.initials: DS
authors.lastname: Likosky
authors.forename: Desmond J
authors.initials: DJ
authors.lastname: Donegan
authors.forename: Robert C
authors.initials: RC
authors.lastname: Groom
authors.forename: Scott A
authors.initials: SA
authors.lastname: Buchanan
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Morton
authors.forename: Cathy S
authors.initials: CS
authors.lastname: Ross
authors.forename: Gerald T
authors.initials: GT
authors.lastname: O'Connor
mesh_terms: D002560:Cerebrovascular Circulation / Q000187:drug effects*; D015331:Cohort Studies; D006801:Humans; D007269:Injections, Intra-Arterial; D020766:Intracranial Embolism / Q000139:chemically induced* / Q000175:diagnosis*; D008323:Mammary Arteries / Q000187:drug effects*; D010208:Papaverine / Q000008:administration & dosage* / Q000009:adverse effects*; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014665:Vasodilator Agents; D010208:Papaverine