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Michael N Diringer - One of the best experts on this subject based on the ideXlab platform.
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intracranial pressure monitoring during intraarterial Papaverine infusion for cerebral vasospasm
American Journal of Neuroradiology, 1998Co-Authors: Dewitte T Cross, Michael N Diringer, Christopher J Moran, E E Angtuaco, James M Milburn, Ralph G DaceyAbstract:PURPOSE Intraarterial Papaverine infusions are performed to reverse cerebral arterial vasospasm resulting from subarachnoid hemorrhage, but such infusions may lead to increases in intracranial pressure (ICP). This study was undertaken to determine when ICP monitoring is indicated during Papaverine treatment. METHODS Seventy-eight vessels were treated in 51 sessions in 28 patients with symptomatic vasospasm. ICP, Papaverine doses, and infusion rates were recorded during treatment sessions. The procedural data, Hunt and Hess scores, Fisher grades, Glasgow Coma Scale scores, and ages for all subjects were reviewed and analyzed retrospectively. RESULTS Baseline ICP ranged from 0 to 34 mm Hg. With typical Papaverine doses of 300 mg per territory and infusion times ranging from 5 to 60 minutes per vessel, ICP increases above baseline during Papaverine infusion ranged from 0 to 60 mm Hg. Significant (> or = 20 mm Hg) ICP increases during therapy were observed even in patients with low baseline ICP and with Papaverine infused at the slowest rate. Patients with a baseline ICP of more than 15 mm Hg were much more likely to have significant ICP increases than were patients with a baseline ICP of 0 to 15 mm Hg. Hunt and Hess scores, Fisher grades, age, and Glasgow Coma Scale scores on admission and immediately before treatment did not correlate with ICP increases during Papaverine infusion. Patients with ICP increases of more than 10 mm Hg during therapy were more likely to experience adverse clinical events than were patients with ICP increases of < or = 10 mm Hg. Reduction in the rate of Papaverine infusion, or termination of infusion, resulted in reversal of drug-induced ICP elevation. CONCLUSION ICP monitoring during intraarterial Papaverine infusions for cerebral vasospasm is recommended for all patients and is particularly important for patients with elevated baseline ICP. Continuous ICP monitoring facilitates safe and time-efficient drug delivery.
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increase in diameters of vasospastic intracranial arteries by intraarterial Papaverine administration
Journal of Neurosurgery, 1998Co-Authors: James M Milburn, Dewitte T Cross, Chris Moran, Michael N Diringer, Thomas K Pilgram, Ralph G DaceyAbstract:Object. This study was conducted to determine if there is a change in intracranial arterial diameters after Papaverine infusion for vasospasm and to determine whether the change occurs in proximal, intermediate, and distal arteries. Methods. The authors measured arterial diameters retrospectively in all patients who received intraarterial Papaverine for treatment of vasospasm between November 1992 and August 1995. Patients who received Papaverine in the same session with or following angioplasty were excluded. Measurements were made in a blinded manner with the aid of a magnification loupe at 12 predetermined sites on each angiogram before and after Papaverine infusion. Eighty-one treatments in 34 patients were included. Angiograms obtained at the time of presentation with subarachnoid hemorrhage (SAH) were examined in 26 of the 34 patients. Nine carotid territories visualized by repeated angiography on the day after infusion were examined to determine the duration of the Papaverine effect. Conclusions. I...
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severe thrombocytopenia following intraarterial Papaverine administration for treatment of vasospasm
Journal of Neurosurgery, 1995Co-Authors: Janice A Miller, Dewitte T Cross, Chris Moran, Ralph G Dacey, Janice G Mcfarland, Michael N DiringerAbstract:✓ Selective intraarterial infusion of Papaverine is used in the treatment of symptomatic cerebral vasospasm. The authors report two episodes of severe thrombocytopenia in a patient that were related to intraarterial administration of Papaverine. A 70-year-old man with a right internal carotid artery aneurysm underwent craniotomy and aneurysm clipping. He became lethargic 8 days after the hemorrhage occurred. Cerebral angiography revealed moderate vasospasm. In addition to hypervolemic—hypertensive therapy, the patient was treated on two occasions with intraarterial administration of Papaverine. Within 24 hours of both treatments he developed severe thrombocytopenia. On one occasion epistaxis requiring transfusion of blood products occurred. Laboratory data support the diagnosis of immune-mediated Papaverine-induced thrombocytopenia. The authors conclude that intraarterial administration of Papaverine for treatment of vasospasm can be associated with severe, rapidly reversible thrombocytopenia.
Ralph G Dacey - One of the best experts on this subject based on the ideXlab platform.
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intracranial pressure monitoring during intraarterial Papaverine infusion for cerebral vasospasm
American Journal of Neuroradiology, 1998Co-Authors: Dewitte T Cross, Michael N Diringer, Christopher J Moran, E E Angtuaco, James M Milburn, Ralph G DaceyAbstract:PURPOSE Intraarterial Papaverine infusions are performed to reverse cerebral arterial vasospasm resulting from subarachnoid hemorrhage, but such infusions may lead to increases in intracranial pressure (ICP). This study was undertaken to determine when ICP monitoring is indicated during Papaverine treatment. METHODS Seventy-eight vessels were treated in 51 sessions in 28 patients with symptomatic vasospasm. ICP, Papaverine doses, and infusion rates were recorded during treatment sessions. The procedural data, Hunt and Hess scores, Fisher grades, Glasgow Coma Scale scores, and ages for all subjects were reviewed and analyzed retrospectively. RESULTS Baseline ICP ranged from 0 to 34 mm Hg. With typical Papaverine doses of 300 mg per territory and infusion times ranging from 5 to 60 minutes per vessel, ICP increases above baseline during Papaverine infusion ranged from 0 to 60 mm Hg. Significant (> or = 20 mm Hg) ICP increases during therapy were observed even in patients with low baseline ICP and with Papaverine infused at the slowest rate. Patients with a baseline ICP of more than 15 mm Hg were much more likely to have significant ICP increases than were patients with a baseline ICP of 0 to 15 mm Hg. Hunt and Hess scores, Fisher grades, age, and Glasgow Coma Scale scores on admission and immediately before treatment did not correlate with ICP increases during Papaverine infusion. Patients with ICP increases of more than 10 mm Hg during therapy were more likely to experience adverse clinical events than were patients with ICP increases of < or = 10 mm Hg. Reduction in the rate of Papaverine infusion, or termination of infusion, resulted in reversal of drug-induced ICP elevation. CONCLUSION ICP monitoring during intraarterial Papaverine infusions for cerebral vasospasm is recommended for all patients and is particularly important for patients with elevated baseline ICP. Continuous ICP monitoring facilitates safe and time-efficient drug delivery.
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increase in diameters of vasospastic intracranial arteries by intraarterial Papaverine administration
Journal of Neurosurgery, 1998Co-Authors: James M Milburn, Dewitte T Cross, Chris Moran, Michael N Diringer, Thomas K Pilgram, Ralph G DaceyAbstract:Object. This study was conducted to determine if there is a change in intracranial arterial diameters after Papaverine infusion for vasospasm and to determine whether the change occurs in proximal, intermediate, and distal arteries. Methods. The authors measured arterial diameters retrospectively in all patients who received intraarterial Papaverine for treatment of vasospasm between November 1992 and August 1995. Patients who received Papaverine in the same session with or following angioplasty were excluded. Measurements were made in a blinded manner with the aid of a magnification loupe at 12 predetermined sites on each angiogram before and after Papaverine infusion. Eighty-one treatments in 34 patients were included. Angiograms obtained at the time of presentation with subarachnoid hemorrhage (SAH) were examined in 26 of the 34 patients. Nine carotid territories visualized by repeated angiography on the day after infusion were examined to determine the duration of the Papaverine effect. Conclusions. I...
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severe thrombocytopenia following intraarterial Papaverine administration for treatment of vasospasm
Journal of Neurosurgery, 1995Co-Authors: Janice A Miller, Dewitte T Cross, Chris Moran, Ralph G Dacey, Janice G Mcfarland, Michael N DiringerAbstract:✓ Selective intraarterial infusion of Papaverine is used in the treatment of symptomatic cerebral vasospasm. The authors report two episodes of severe thrombocytopenia in a patient that were related to intraarterial administration of Papaverine. A 70-year-old man with a right internal carotid artery aneurysm underwent craniotomy and aneurysm clipping. He became lethargic 8 days after the hemorrhage occurred. Cerebral angiography revealed moderate vasospasm. In addition to hypervolemic—hypertensive therapy, the patient was treated on two occasions with intraarterial administration of Papaverine. Within 24 hours of both treatments he developed severe thrombocytopenia. On one occasion epistaxis requiring transfusion of blood products occurred. Laboratory data support the diagnosis of immune-mediated Papaverine-induced thrombocytopenia. The authors conclude that intraarterial administration of Papaverine for treatment of vasospasm can be associated with severe, rapidly reversible thrombocytopenia.
Paul Schramek - One of the best experts on this subject based on the ideXlab platform.
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intracavernous injection of prostagland in e1 in combination with Papaverine enhanced effectiveness in comparison with Papaverine plus phentolamine and prostaglandin e1 alone
The Journal of Urology, 1991Co-Authors: Andreas Floth, Paul SchramekAbstract:AbstractWe compared the erectile response to intracavernous injection of a combination of Papaverine and prostaglandin E1 with that of a combination of Papaverine and phentolamine (49 patients), and prostaglandin E1 alone (38). The degree of erection achieved was significantly better with Papaverine plus prostaglandin E1 than with Papaverine plus phentolamine and the duration of erection was less, although the incidence of prolonged erections (greater than 5 hours) was similar with both combinations. Papaverine with prostaglandin E1 likewise resulted in a significantly better degree of erection than prostaglandin E1 alone (prolonged erections occurred only after the drug combination). All erections subsided spontaneously and none required medical intervention throughout the study. Pain was noted only after injection of prostaglandin E1. The incidence was clearly lower (7 of 38 versus 13 of 38) after the injection of only 5µg. prostaglandin E1 in combination with Papaverine (although the difference is not ...
Dewitte T Cross - One of the best experts on this subject based on the ideXlab platform.
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intracranial pressure monitoring during intraarterial Papaverine infusion for cerebral vasospasm
American Journal of Neuroradiology, 1998Co-Authors: Dewitte T Cross, Michael N Diringer, Christopher J Moran, E E Angtuaco, James M Milburn, Ralph G DaceyAbstract:PURPOSE Intraarterial Papaverine infusions are performed to reverse cerebral arterial vasospasm resulting from subarachnoid hemorrhage, but such infusions may lead to increases in intracranial pressure (ICP). This study was undertaken to determine when ICP monitoring is indicated during Papaverine treatment. METHODS Seventy-eight vessels were treated in 51 sessions in 28 patients with symptomatic vasospasm. ICP, Papaverine doses, and infusion rates were recorded during treatment sessions. The procedural data, Hunt and Hess scores, Fisher grades, Glasgow Coma Scale scores, and ages for all subjects were reviewed and analyzed retrospectively. RESULTS Baseline ICP ranged from 0 to 34 mm Hg. With typical Papaverine doses of 300 mg per territory and infusion times ranging from 5 to 60 minutes per vessel, ICP increases above baseline during Papaverine infusion ranged from 0 to 60 mm Hg. Significant (> or = 20 mm Hg) ICP increases during therapy were observed even in patients with low baseline ICP and with Papaverine infused at the slowest rate. Patients with a baseline ICP of more than 15 mm Hg were much more likely to have significant ICP increases than were patients with a baseline ICP of 0 to 15 mm Hg. Hunt and Hess scores, Fisher grades, age, and Glasgow Coma Scale scores on admission and immediately before treatment did not correlate with ICP increases during Papaverine infusion. Patients with ICP increases of more than 10 mm Hg during therapy were more likely to experience adverse clinical events than were patients with ICP increases of < or = 10 mm Hg. Reduction in the rate of Papaverine infusion, or termination of infusion, resulted in reversal of drug-induced ICP elevation. CONCLUSION ICP monitoring during intraarterial Papaverine infusions for cerebral vasospasm is recommended for all patients and is particularly important for patients with elevated baseline ICP. Continuous ICP monitoring facilitates safe and time-efficient drug delivery.
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increase in diameters of vasospastic intracranial arteries by intraarterial Papaverine administration
Journal of Neurosurgery, 1998Co-Authors: James M Milburn, Dewitte T Cross, Chris Moran, Michael N Diringer, Thomas K Pilgram, Ralph G DaceyAbstract:Object. This study was conducted to determine if there is a change in intracranial arterial diameters after Papaverine infusion for vasospasm and to determine whether the change occurs in proximal, intermediate, and distal arteries. Methods. The authors measured arterial diameters retrospectively in all patients who received intraarterial Papaverine for treatment of vasospasm between November 1992 and August 1995. Patients who received Papaverine in the same session with or following angioplasty were excluded. Measurements were made in a blinded manner with the aid of a magnification loupe at 12 predetermined sites on each angiogram before and after Papaverine infusion. Eighty-one treatments in 34 patients were included. Angiograms obtained at the time of presentation with subarachnoid hemorrhage (SAH) were examined in 26 of the 34 patients. Nine carotid territories visualized by repeated angiography on the day after infusion were examined to determine the duration of the Papaverine effect. Conclusions. I...
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severe thrombocytopenia following intraarterial Papaverine administration for treatment of vasospasm
Journal of Neurosurgery, 1995Co-Authors: Janice A Miller, Dewitte T Cross, Chris Moran, Ralph G Dacey, Janice G Mcfarland, Michael N DiringerAbstract:✓ Selective intraarterial infusion of Papaverine is used in the treatment of symptomatic cerebral vasospasm. The authors report two episodes of severe thrombocytopenia in a patient that were related to intraarterial administration of Papaverine. A 70-year-old man with a right internal carotid artery aneurysm underwent craniotomy and aneurysm clipping. He became lethargic 8 days after the hemorrhage occurred. Cerebral angiography revealed moderate vasospasm. In addition to hypervolemic—hypertensive therapy, the patient was treated on two occasions with intraarterial administration of Papaverine. Within 24 hours of both treatments he developed severe thrombocytopenia. On one occasion epistaxis requiring transfusion of blood products occurred. Laboratory data support the diagnosis of immune-mediated Papaverine-induced thrombocytopenia. The authors conclude that intraarterial administration of Papaverine for treatment of vasospasm can be associated with severe, rapidly reversible thrombocytopenia.
Christoph N. Seubert - One of the best experts on this subject based on the ideXlab platform.
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Transient bilateral brainstem dysfunction caused by topical administration of Papaverine.
Journal of neurosurgery, 2011Co-Authors: Colleen M Moran, Michael E Mahla, Brett Reichwage, Keith Peters, Stephen Lewis, Christoph N. SeubertAbstract:Papaverine has been associated with transient cranial nerve dysfunction after topical application during craniotomy. The authors report similar dysfunction after the use of Papaverine affected brainstem structures. Two patients undergoing craniotomy for clipping of an aneurysm experienced bilateral depression of cortical somatosensory evoked potentials to both median and tibial nerve stimulation after administration of Papaverine. Arterial blood gas analysis, hemodynamic parameters, and anesthetic levels remained constant throughout these somatosensory evoked potential changes. In addition, intraoperative angiography and immediate postoperative CT imaging showed intact blood flow with complete exclusion of the aneurysm. Both patients recovered within 1-2 hours and had normal neurological examination findings after extubation. Topical Papaverine use may be associated with direct effects on brainstem structures. The transient nature of those changes suggests that aggressive intervention may not be needed. Maneuvers to limit the spread of Papaverine to basal cisterns should be considered.
