The Hemodynamic Effects of Intracavernosal Phenylephrine for the Treatment of Ischemic Priapism
| Autor: | Billy H. Cordon, Bu J. Kim, Ajaydeep S. Sidhu, Alexander G.S. Anderson, A. Scott Polackwich, Jorge Caso, George Wayne |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Urology Endocrinology Diabetes and Metabolism Priapism 030232 urology & nephrology Vital signs Diastole Blood Pressure Injections Phenylephrine 03 medical and health sciences 0302 clinical medicine Endocrinology Heart Rate Ischemia Interquartile range Heart rate Humans Vasoconstrictor Agents Medicine Adverse effect Retrospective Studies 030219 obstetrics & reproductive medicine Dose-Response Relationship Drug business.industry Emergency department Middle Aged medicine.disease Psychiatry and Mental health Blood pressure Reproductive Medicine Anesthesia business |
| Zdroj: | The Journal of Sexual Medicine. 15:990-996 |
| ISSN: | 1743-6109 1743-6095 |
| Popis: | Aim We sought to evaluate whether the administration of phenylephrine (PE) at concentrations higher than those described in guidelines resulted in any significant changes in vital signs or impacted outcomes. Methods After receiving institutional review board approval, we retrospectively reviewed the charts of patients presenting to our emergency department between May 1, 2014, and August 15, 2016, using International Classification of Diseases, Ninth Edition and Internation Classification of Disease, Tenth Edition diagnosis codes for priapism. Treatment was reviewed, including corporal aspiration/irrigation, injection of PE, and shunt procedures. Vital signs were compared before and after treatment with PE. Baseline variables were explored with categorical data analysis (chi-squared tests, t-tests, and Mann-Whitney nonparametric tests). Where feasible, linear regression was used to evaluate outcomes. Main Outcome Measure Detumescence and changes in blood pressure and heart rate. Results We identified 74 different patient encounters of acute priapism. The median age was 36.5 years (interquartile range [IQR] = 27–47), and the median time to presentation was 5.4 hours (IQR = 4.0–9.6). 62 percent of cases were due to drug-induced priapism. In 58 (74%) encounters, patients received PE. The median dose of PE given was 1000 μg (IQR 500–2,000). Univariate regression found no association between PE dose and change in patient heart rate or blood pressure. A statistically significant decrease in heart rate (HR) (−4.2 BPM), systolic blood pressure (BP) (−1.8 mm Hg), and diastolic BP (−5.4 mm Hg) was noted. Fifty-three of 58 (91%) patients receiving PE experienced detumescence at the bedside, 2 required shunting in operating room, and 3 refused treatment and left against medical advice. No adverse events occurred. Conclusion We frequently treat patients with high doses of PE and seldom notice adverse effects, typically resulting in resolution of priapism without any additional procedures. Careful administration of high doses of intracavernosal PE in patients presenting with priapism does not appear to significantly affect heart rate or blood pressure and may help prevent further ischemic damage and achieve detumescence effectively and efficiently. |
| Databáze: | OpenAIRE |
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