Effect of intracarotid papaverine on human cerebral blood flow and vascular resistance during acute hemispheric arterial hypotension

Document Type

Article

Abstract

This study assessed the feasibility of augmenting cerebral blood flow (CBF) and decreasing hemispheric cerebrovascular resistance (CVR) by intracarotid papaverine during acute cerebral hypotension. Awake patients (n = 10) undergoing transfemoral balloon occlusion of an internal carotid artery (ICA) with nitroprusside (SNP)-induced systemic hypotension (10% reduction of mean arterial pressure) were studied. We measured mean femoral artery pressure (MAP), mean distal ICA pressure (Pica), and CBF (intracarotid 133Xe) at two time points: before and after intracarotid papaverine infusion (1 or 7 mg/min). Two patients became symptomatic immediately after ICA occlusion and were excluded. One patient developed a focal seizure during papaverine infusion. In another, the occlusion balloon deflated prematurely. Of the remaining six patients, two of the three patients who received high-dose papaverine (7 mg/min) developed transient obtundation. The remaining three patients, who received low-dose papaverine (1 mg/min), did not develop any neurologic symptoms. There was a trend for intracarotid papaverine to increase hemispheric CBF by 36% (33 ± 10 versus 45 ± 22 ml · 100 g-1 · min-1, P = .084, n = 6); papaverine decreased CVR from 1.3 ± 0.4 to 1.0 ± 0.3 mm Hg · m1-1 · 100 g-1 · min-1 (P = .049). There was no significant change in heart rate, MAP, or Pica during experimental protocol. Manipulation of CVR by intracarotid papaverine during acute hemispheric arterial hypotension appears to be feasible. Further studies are needed to establish safety and efficacy.

Keywords

Carotid occlusion, Cerebral blood flow, Cerebrovascular resistance, Intra-arterial drug, Papaverine

Publication Date

4-10-2001

Publication Title

Journal of Neurosurgical Anesthesiology

ISSN

08984921

Volume

13

Issue

2

First Page

146

Last Page

151

PubMed ID

11294457

Digital Object Identifier (DOI)

10.1097/00008506-200104000-00013

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