Papaverine
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Hypotension: case report A 53-year-old man, with a subarachnoid haemorrhage due to a ruptured right middle cerebral artery aneurysm, developed refractory hypotension after receiving intracisternal papaverine following surgical clipping of his aneurysm. The man’s mean arterial BP was 100mm Hg after surgical clipping. His cisternal space was filled with papaverine 30mg diluted in normal saline 100mL at the end of dural closure. His mean arterial BP decreased rapidly to 40mm Hg. The man’s hypotension was resistant to treatment with IV fluids and inotropes over the next hour. His systolic BP was then maintained at 90 to 110mm Hg using separate infusions of dopamine, norepinephrine [noradrenaline], epinephrine [adrenaline], and intermittent ephedrine boluses. He was drowsy postoperatively, and had a hemiplegia on his left side. On postoperative day 2, a cranial CT scan showed hypodensities in his right basal ganglia. Mechanical ventillation was continued. From day 4, his haemodynamic status started to improve, and inotropic support was able to be withdrawn over another week. His postoperative course was ‘stormy’, with obtunded consciousness, deep vein thrombosis and respiratory infection. He gradually regained consciousness and was weaned from mechanical ventillation after 3 weeks. At discharge on postoperative day 45, he had a grade 3/5 monoparesis in his left lower limb. Author comment: "Some earlier reports suggest that intracisternal papaverine might affect hypothalamic or brainstem function as evidenced by hyperthermia and pupillary signs. Respiratory arrest and progressive loss of brainstem function have been reported after infusion of papaverine into cerebral arteries. The hypotension in our case, possibly, is another manifestation of brainstem or hypothalamic dysfunction caused by papaverine." Reddy KRM, et al. Profound hypotension after intracisternal papaverine. Journal of 801044243 Neurosurgical Anesthesiology 18: 221, No. 3, Jul 2006 - India
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Reactions 23 Sep 2006 No. 1120
