China
Africa
Explore chapters and articles related to this topic
Upper Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Specific measures Local anaesthetic injectionIntra-arterial injection of lignocaine through the implicated cannula may be useful in preventing reflex vasospasm. But this can cause further damage and compromise the perfusion to the affected limb.SympatholysisStellate ganglion blocks and lower-extremity sympathetic blocks can produce arterial and venous vasodilatation which can also be a good mode of analgesia but should be done after risk-benefit analysis.Other drugsCalcium channel blockers, thromboxane inhibitors (aspirin and methylprednisolone), prostacyclin analogues, intra-arterial papaverine have been used for their vasodilatory and platelet-inhibiting properties to varying success.
Medications for endovascular therapy
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Papaverine is a smooth muscle relaxant and can be administered as a bolus (15–30 mg) or as an infusion at 1–3 mg/minute. Papaverine is most commonly used to produce extremity vasodilation in an effort to elicit evidence of the hemodynamic significance of a lesion. Papaverine will precipitate with heparin. For this reason, the author prefers nitroglycerine (20–100 μg), which is administered to prevent or treat vasospasm that may occur during endovascular therapy. Keep in mind that nitroglycerine administered into the cerebral circulation can cause headache. Vasodilators may also cause hypotension, but this is unusual at the small doses required for administration locally into an arterial segment. In the peripheral vasculature, especially in the lower extremity, verapamil may also be used.
Erectile dysfunction and Peyronie’s disease
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Trinity J Bivalacqua, Mohamad E Allaf
Tri-mix: In an attempt to maximize efficacy and minimize side effects, a combination of PGE1, papaverine, and phentolamine as a tri-mix is utilizedA common mixture is papaverine, 120 mg (4 ml of 30 mg/ml); phentolamine, 6 mg; and PGE1, 120 μg (6 ml of 20 mg/ml) to make a total volume of 10 mlThe reliable patient can titrate his intracavernosal dose from 0.2 to 0.5 ml to optimize his erectile response.
An update on the drug safety of treating erectile dysfunction
Published in Expert Opinion on Drug Safety, 2019
Papaverine––a non- specific PDEI––was the first agent discovered to improve penile erections as a way of intracavernosal therapy [4]. It increases intracellular cyclic adenosine monophosphate (cAMP) along with cGMP levels and inhibits voltage-dependent calcium channels leading to cavernosal smooth muscle relaxation [109]. A retrospective study evaluating the records of patients who underwent penile Doppler ultrasonography with the intracorporeal injection of 60 mg papaverine hydrochloride revealed 2.7% incidence of prolonged erection (priapism) [110]. Those patients were successfully treated with blood aspiration, irrigation and injection of an a-agonist medication, when needed. Several reports also draw an association between its use and hepatotoxicity [111]. Penile curvature is another reported complication of long-term intracavernosal papaverine self-injection [112]. Thus, the use of papaverine as a monotherapy is restricted and this drug is reserved for combination therapies with lower concentrations.
Anti-vasospastic effects of botulinum toxin B pretreatment in animal models
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Jeongmin Yoon, Eul-Sik Yoon, Byung-Il Lee, Seung-Ha Park, Jin Woo Kim
Many pharmacological agents have been investigated with the goal of preventing intraoperative and postoperative vasospasm. Papaverine hydrochloride, directly acting on the smooth muscle cells of the vessels, is widely used during surgery to prevent vasospasm. Furthermore, Yokoyama et al. demonstrated that the topical application of lidocaine on the recipient vessel decreased the rate of vasospasm and thrombosis after microsurgery for the upper and lower extremities [17]. By inhibiting calcium influx into the cell and decreasing the contractile response, calcium-channel blockers such as verapamil and nifedipine effectively prevent vasospasm and induce vasodilatation following the anastomosis of vessels [18]. However, most of these pharmacological agents can cause unexpected systemic effects that are deleterious for patients. Furthermore, there is no effective means of preoperatively preventing vasospasm. Therefore, many studies have recently been conducted to examine anti-vasospastic agents that have a local effect on vessels.
Fractional flow reserve (FFR) as a guide to treat coronary artery disease
Published in Expert Review of Cardiovascular Therapy, 2018
Fabio Mangiacapra, Edoardo Bressi, Alessandro Sticchi, Carmine Morisco, Emanuele Barbato
Papaverine is an opium alkaloid thought to have a phosphodiesterase inhibiting properties, which acts by increasing cAMP in the vascular smooth muscle [30,31]. At high dose, papaverine may have also had a direct inhibitory effect on calcium mobilization in the vascular smooth muscle cell [30,31]. IC doses of 20 mg of papaverine have been shown to be as efficacious as adenosine at producing coronary hyperemia [23]. Its longer half-life (1–2 h) produces a sustained hyperemic response so that, unlike IC adenosine, FFR pullbacks can be performed. However, papaverine can predispose to ventricular arrhythmias due to prolongation of the QT interval [30,31]. For these reasons, its use as a first-line agent for producing hyperemia for FFR assessment is not recommended.