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Ann Thorac Surg 1996;62:769-771
© 1996 The Society of Thoracic Surgeons
erbetçio
lu, MDDepartments of Cardiovascular Surgery and Anesthesiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
Accepted for publication April 30, 1996.
Background. After mobilization, vasospasm often reduces flow through the internal thoracic artery. An established method of relaxing the artery and increasing flow is to use papaverine at ambient temperature (20° to 22°C) as a topical vasodilator. However, the pharmacologic actions of papaverine generally have been assessed at 37°C.
Methods. In 60 patients in whom the left internal thoracic artery was used for myocardial revascularization, we investigated the effects of normal saline solution at 20°C (group I), papaverine at 20°C (group II), and papaverine at 37°C (group III). Under controlled hemodynamic conditions, free flow was measured before any pharmacologic intervention and a median of 16 minutes after the pedicle had been sprayed with one of the agents.
Results. Normal saline solution at 20°C produced a small increase in flow from 37.5 ± 8.1 mL/min to 50 ± 10.2 mL/min. A significant increase occurred with papaverine at 20°C, from 38.05 ± 6.5 mL/min to 78.75 ± 21.2 mL/min (p< 0.0001). Papaverine at 37°C, however, produced an increase in flow from 36.9 ± 12.6 mL/min to 103.3 ± 44.6 mL/min (p < 0.0001) and proved to be more effective than papaverine at room temperature (p = 0.0174).
Conclusions. We recommend topical use of papaverine at 37°C to relieve intraoperative spasm of the internal thoracic artery.
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