We have located links that may give you full text access.
Topical nitroglycerin for the treatment of intraoperative microsurgical vasospasm.
Microsurgery 2018 January 18
BACKGROUND: Papaverine remains a popular agent to treat intraoperative microsurgical vasospasm. However, the recent shortage has forced surgeons to trial antispasmodic agents unproven in microsurgery, but commonly used in other areas. During this shortage we have trialed topical nitroglycerin to break intraoperative vasospasm. This study aims to analyze the outcomes of this medication on flap complications compared with papaverine.
METHODS: All consecutive free flaps performed for breast reconstruction at a single institution were reviewed. Data collected included patient demographics, co-morbidities, complications and type of antispasmodic agent. Rates of re-exploration, complications and flap salvage were compared between patients receiving nitroglycerin and papaverine.
RESULTS: Over 10 years, 991 flaps were treated with antispasmodics: 18 of which were treated with topical nitroglycerin. Patients treated with nitroglycerin tended to have higher BMI (32.1 vs. 27.9, P < 0.01), higher rates of pre-operative chemotherapy (83.3% vs. 51.3%, P < 0.01) and shorter follow-up duration (735 vs. 1691 days, P < 0.01). However, no differences in complications were observed, including: unplanned return to the operating room, flap loss, fat necrosis, infection, hematoma, or seroma. Subgroup analysis with a time-matched cohort of papaverine patients revealed minimal difference in comorbidities and no difference in complications.
CONCLUSIONS: Substituting topical nitroglycerin for papaverine to treat vasospasm during the shortage did not demonstrate an increased rate of flap loss or return to the operating room, making these medications a safe alternative to papaverine.
METHODS: All consecutive free flaps performed for breast reconstruction at a single institution were reviewed. Data collected included patient demographics, co-morbidities, complications and type of antispasmodic agent. Rates of re-exploration, complications and flap salvage were compared between patients receiving nitroglycerin and papaverine.
RESULTS: Over 10 years, 991 flaps were treated with antispasmodics: 18 of which were treated with topical nitroglycerin. Patients treated with nitroglycerin tended to have higher BMI (32.1 vs. 27.9, P < 0.01), higher rates of pre-operative chemotherapy (83.3% vs. 51.3%, P < 0.01) and shorter follow-up duration (735 vs. 1691 days, P < 0.01). However, no differences in complications were observed, including: unplanned return to the operating room, flap loss, fat necrosis, infection, hematoma, or seroma. Subgroup analysis with a time-matched cohort of papaverine patients revealed minimal difference in comorbidities and no difference in complications.
CONCLUSIONS: Substituting topical nitroglycerin for papaverine to treat vasospasm during the shortage did not demonstrate an increased rate of flap loss or return to the operating room, making these medications a safe alternative to papaverine.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
Perioperative echocardiographic strain analysis: what anesthesiologists should know.Canadian Journal of Anaesthesia 2024 April 11
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app