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J Thorac Cardiovasc Surg 2003;126:1798-1805
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Comparative efficacies and durations of action of phenoxybenzamine, verapamil/nitroglycerin solution, and papaverine as topical antispasmodics for radial artery coronary bypass grafting

^a Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom,
^b Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom

Received for publication September 9, 2002; revisions received November 12, 2002; accepted for publication March 25, 2003.

^* Address for reprints: David P. Taggart, MD, PhD, FRCS, Consultant Cardiothoracic Surgeon, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom
david.taggart{at}orh.nhs.uk

OBJECTIVE: Radial arteries are increasingly used as conduits for coronary artery bypass grafts, but perioperative graft vasospasm continues to be a concern. Phenoxybenzamine, verapamil/nitroglycerin solution, and papaverine have been advocated as topical antispasmodic agents. We compared the relative efficacies and durations of action of these agents.

METHODS: Isometric tension developed in response to clinically important vasoconstrictors was measured in 100 radial artery rings (from patients undergoing coronary artery bypass grafting, n = 25) after 15 minutes of ex vivo incubation with phenoxybenzamine, verapamil/nitroglycerin solution, papaverine, or vehicle (control). Duration of action was assessed by measuring responses to vasoconstrictors in antispasmodic pretreated and control rings at intervals through 5 hours.

RESULTS: Verapamil/nitroglycerin solution reduced vasoconstriction in response to epinephrine, angiotensin II, prostaglandin F₂, and phenylephrine but its effect had almost completely waned after 5 hours. Phenoxybenzamine prevented vasoconstriction in response to epinephrine, dopamine, and phenylephrine, with its effect lasting at least 5 hours. Papaverine had limited antispasmodic efficacy and prevented vasoconstriction in response to potassium (60 mmol/L) and phenylephrine for only 1 hour at the longest.

CONCLUSIONS: Verapamil/nitroglycerin solution has a broad efficacy against a range of vasoconstrictors but a limited duration of action. Papaverine has the shortest duration of action. Phenoxybenzamine is an effective agent with a prolonged duration of action, specifically preventing catecholamine mediated vasospasm of radial artery conduits.

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