Haemodynamic changes after intracisternal papaverine instillation during intracranial aneurysmal surgery.
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.
Rath
G P
GP
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India. girijarath@yahoo.co.in
Mukta
Prabhakar
H
H
Dash
H H
HH
Suri
A
A
D000287:Administration, Topical; D001919:Bradycardia / Q000139:chemically induced*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D002532:Intracranial Aneurysm / Q000601:surgery*; D007431:Intraoperative Complications / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D010208:Papaverine / Q000009:adverse effects*; D014665:Vasodilator Agents / Q000009:adverse effects*; D020301:Vasospasm, Intracranial / Q000517:prevention & control; D014696:Ventriculostomy
D014665:Vasodilator Agents; D010208:Papaverine