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BJA Advance Access published online on September 19, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael248
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted August 8, 2006

Case Report

Haemodynamic changes after intracisternal papaverine instillation during intracranial aneurysmal surgery

G. P. Rath 1 *, Mukta 1, H. Prabhakar 1, H. H. Dash 1, and A. Suri 2

1 Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

* To whom correspondence should be addressed.
G. P. Rath, E-mail: girijarath{at}yahoo.co.in


  Abstract

Cerebral vasospasm remains a significant cause of mortality and morbidity after aneurysmal subarachnoid haemorrhage. Use of either intra-arterial or intracisternal papaverine as an alternative treatment of refractory cerebral vasospasm has been associated with various complications including haemodynamic instabilities. However, our search in literature did not reveal association of bradycardia and hypotension with the use of papaverine by either of these routes. Here, we describe a case of anterior communicating artery aneurysm with hydrocephalus. The patient underwent craniotomy and clipping of the aneurysm followed by third ventriculostomy. Instillation of papaverine at the surgical site caused significant haemodynamic changes possibly because of stimulation of hypothalamus in the third ventricle or vagal nuclei in the fourth ventricle, or even both. We recommend cautious use of intracisternal papaverine in such scenario especially when third ventriculostomy has been performed as an adjunct surgical procedure.

Keywords: brain, hypothalamus, floor of fourth ventricle; complications, haemodynamic; drug, papaverine; drug delivery, intracisternal; surgery, aneurysm.
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