CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2024; 43(01): e65-e68
DOI: 10.1055/s-0041-1730371
Case Report

Hypotension and Bradycardia Following Papaverine Installation During Intracranial Aneurysm Surgery: A Report of Three Cases

Hipotensão e bradicardia devido à papaverina intracisternal quando instilada durante a cirurgia de aneurisma: Um relato de três casos
1   Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
,
1   Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
,
Mustafa E. Almurayati
2   College of Medicine, University of Baghdad, Baghdad, Iraq
,
Teeba M. Ghanim
2   College of Medicine, University of Baghdad, Baghdad, Iraq
,
Zahraa M. Kareem
2   College of Medicine, University of Baghdad, Baghdad, Iraq
,
Zahraa A. Alsubaihawi
2   College of Medicine, University of Baghdad, Baghdad, Iraq
› Author Affiliations

Abstract

Introduction One of the major complications of intracranial aneurysm surgery is vasospasm. Papaverine is an effective vasodilator that can be instilled directly onto the vessels in the operative field with the aim of preventing intraoperative and postoperative vasospasm. Several case reports of hemodynamic instability in general and of hypotension, in particular, were reported after the use of topical papaverine during aneurysm clipping surgery.

Case description Herein, we report three cases of transient profound hypotension and relative bradycardia after intracisternal papaverine usage during ruptured anterior communicating artery aneurysm clipping surgery.

Conclusion Caution should be taken while using papaverine intracisternally during anterior circulation aneurysm clipping, since it may cause several serious complications, including profound hemodynamic instability, particularly when instilling on a fenestrated lamina terminalis.

Resumo

Introdução Uma das principais complicações da cirurgia de aneurisma intracraniano é o vasoespasmo. A papaverina é um vasodilatador eficaz que pode ser instilado diretamente nos vasos do campo operatório com o objetivo de prevenir o vasoespasmo intra e pós-operatório. Vários relatos de casos de instabilidade hemodinâmica em geral e de hipotensão, em particular, foram relatados após o uso de papaverina tópica durante cirurgia de clipagem de aneurisma.

Descrição de caso Aqui, relatamos três casos de hipotensão profunda transitória e bradicardia relativa após o uso de papaverina intracisternal durante a cirurgia de clipagem de aneurisma da artéria comunicante anterior rompida.

Conclusão Deve-se ter cuidado ao usar papaverina intracisternamente durante a clipagem do aneurisma da circulação anterior, uma vez que pode causar várias complicações graves, incluindo profunda instabilidade hemodinâmica, particularmente ao instilar em uma lâmina terminal fenestrada.

Contributions of the Authors

Hoz S. S.: Case identification, manuscript drafting, literature review


Al-Sharshahi Z. F.: Manuscript review, revision of the original draft


Almurayati M. E.: Revision of the original draft


Ghanim T. M.: Revision of the original draft


Kareem Z. M.: Revision of the original draft


Alsubaihawi Z. A.: Revision of the original draft




Publication History

Received: 04 April 2020

Accepted: 22 February 2021

Article published online:
10 October 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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