| Preventing gastroepiploic artery spasm: papaverine vs calcium channel blockade. | |
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MedLine Citation:
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PMID: 9271276 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The gastroepiploic artery (GEA) is a highly vasoactive artery gaining wider acceptance as a conduit for coronary artery bypass surgery. A variety of agents are used to dilate the GEA prior to grafting; however, little is known about the duration of their effect in the immediate postoperative period. This study evaluated three calcium channel blockers and papaverine in preventing graft spasm. METHODS: Porcine GEA segments (10-12 cm in length) were connected to a computer-controlled perfusion system with a constant in-flow pressure and distal resistance to simulate bypass flow (80-100 ml/min). Norepinephrine (NE; 10(-9) to 10(-5) M) was given in incremental doses at baseline before the vasodilator, immediately after (0 hr), and again at 2 hr after the vasodilator. Changes in flow and ED50 were recorded. Group INT (N = 25) received papaverine (PAP), diltiazem, nifedipine (NFP), or verapamil (VPL) intraluminally, while group EXT (N = 25) received the same dilators externally. RESULTS: All arteries showed dose-dependent vasoconstriction to NE prior to treatment. Immediately after receiving the vasodilator, arteries in both groups (INT and EXT) showed initial protection against NE-induced spasm with the exception of arteries receiving NFD externally. However, at 2 hr, for group INT, only VPL and NFD prevented NE-induced graft spasm (VPL: 40.4 +/- 6.8 ml/min vs 17.9 +/- 3.3 ml/min and NFD: 27.0 +/- 6.5 ml/min vs 13.1 +/- 0.9 ml/min, P < 0.02). In group EXT, after 2 hr, only VPL- and PAP-treated grafts showed resistance to NE-induced vasospasm (VPL: 35.6 +/- 7.3 ml/min vs 15.0 +/- 6.9 ml/min and PAP: 47.4 +/- 15.1 ml/min vs 8.0 +/- 2.0 ml/min, P < 0.001). CONCLUSIONS: Papaverine, a lipophilic vasodilator, when given externally on the perivascular fat of the GEA, prevented graft spasm for up to 2 hr. In contrast, intraluminally applied papaverine did not show graft protection against NE-induced spasm. Nifedipine prevented NE-induced spasm only when given intraluminally. Verapamil proved to be the most potent and versatile vasodilator with effective graft protection of up to 2 hr whether applied externally or internally and was the preferred agent for protecting against GEA spasm. |
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Authors:
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A T Ali; W D Montgomery; W P Santamore; P A Spence |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of surgical research Volume: 71 ISSN: 0022-4804 ISO Abbreviation: J. Surg. Res. Publication Date: 1997 Jul |
Date Detail:
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Created Date: 1997-09-04 Completed Date: 1997-09-04 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0376340 Medline TA: J Surg Res Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 41-8 Citation Subset: IM |
Affiliation:
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Division of Thoracic and Cardiovascular Surgery, University of Louisville, Kentucky 40202, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Arteries / surgery* Calcium Channel Blockers / therapeutic use* Coronary Artery Bypass / methods* Norepinephrine / pharmacology Papaverine / therapeutic use* Perfusion Stomach / blood supply Swine Time Factors Vasoconstriction / drug effects Vasodilator Agents / therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Calcium Channel Blockers; 0/Vasodilator Agents; 51-41-2/Norepinephrine; 58-74-2/Papaverine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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