Intravenous Infusion Of Iloprost Research Articles

Iloprost and Organ Dysfunction in Adults With Septic Shock and Endotheliopathy

Soluble thrombomodulin is a marker of endotheliopathy, and iloprost may improve endothelial function. In patients with septic shock, high plasma levels of soluble thrombomodulin (>10 ng/mL) have been associated with worse organ dysfunction and mortality. To assess the effects of treatment with iloprost vs placebo on the severity of organ failure in patients with septic shock and plasma levels of soluble thrombomodulin higher than 10 ng/mL. This investigator-initiated, adaptive, parallel group, stratified, double-blind randomized clinical trial was conducted between November 1, 2019, and July 5, 2022, at 6 hospitals in Denmark. The trial had a maximum sample size of 380, with an interim analysis for futility only at 200 patients with 90 days of follow-up. In total, 279 adults in the intensive care unit (ICU) with septic shock and endotheliopathy were included. Patients were randomized 1:1 to masked intravenous infusion of iloprost, 1 ng/kg/min (n = 142), or placebo (n = 137) for 72 hours. The primary outcome was mean daily Sequential Organ Failure Assessment (SOFA) score in the ICU adjusted for trial site and baseline SOFA score for the per-protocol population. SOFA scores for each of the 5 organ systems ranged from 0 to 4, with higher scores indicating more severe dysfunction (maximum score, 20). The secondary outcomes included serious adverse reactions and serious adverse events at 7 days and mortality at 90 days. Of 279 randomized patients, data from 278 were analyzed (median [IQR] age, 69 [58-77] years; 171 (62%) male), 142 in the iloprost group and 136 in the placebo group. The trial was stopped for futility at the planned interim analysis. The mean [IQR] daily SOFA score was 10.6 (6.4-14.8) in the iloprost group and 10.5 (5.9-15.5) in the placebo group (adjusted mean difference, 0.2 [95% CI, -0.8 to 1.2]; P = .70). Mortality at 90 days in the iloprost group was 57% (81 of 142) vs 51% (70 of 136) in the placebo group (adjusted relative risk, 1.12 [95% CI, 0.91-1.40]; P = .33). Serious adverse events occurred in 26 of 142 patients (18%) for the iloprost group vs 20 of 136 patients (15%) for the placebo group (adjusted relative risk, 1.25 [95% CI, 0.73-2.15]; P = .52). Only 1 serious adverse reaction was observed. In this randomized clinical trial of adults in the ICU with septic shock and severe endotheliopathy, infusion of iloprost, 1 ng/kg/min, for 72 hours did not reduce mean daily SOFA scores compared with placebo. In a clinical context, administration of iloprost will be unlikely to improve outcome in these patients. ClinicalTrials.gov Identifier: NCT04123444.

Long peripheral catheters for intravenous infusions of iloprost or alprostadil therapy in rheumatologic outpatients.

Long peripheral catheters (LPCs) role in Difficult IntraVenous Access (DIVA) patients admitted to the emergency department has already been studied, resulting in a rapid, safe, and cost-effective procedure. Although their use in outpatient settings is established, there is a lack of studies assessing their benefits. In particular, rheumatologic outpatients affected by scleroderma, especially those affected by digital ulcers, are often treated with intravenous infusions of prostaglandin I2 (PGI2) analog (IV-PGI2A). From 1 October 2021 to 31 March 2024, we conducted a prospective study enrolling DIVA outpatients affected by systemic sclerosis or undifferentiated connective tissue disease who needed IV-PGI2A therapy at L. Sacco Hospital in Milan (Italy). Each treatment cycle consisted of four consecutive days of infusion of iloprost or alprostadil. The primary aim was to assess the efficacy and potential complications associated with LPCs for IV-PGI2A. Twenty-six patients were enrolled 23 were females (88.5%), and the median age was 72 years (IQR 56-78.7). In total, 97 LPCs were inserted, with a mean number of insertions per patient/year of 2.3. An increase in LPCs insertion during the 30 months of the enrollment period was observed. Eighteen patients required more than one LPC placement, and in 61% of them, the second venipuncture was executed at a different site. No procedural complications were registered (accidental puncture of the brachial artery, accidental median nerve puncture, bleeding) nor late complications (Catheter-Related Thrombosis, Catheter-Related Bloodstream Infections, Accidental Removal). Our experience shows that LPCs could be valuable and safe for rheumatologic outpatients. The increased number of insertions and new and total patients enrolled each year defines the satisfaction of patients and health care professionals.

Combined Thenar and Hypothenar Hammer Syndromes and Raynaud's Phenomenon Successfully Treated with Iloprost.

Thenar and hypothenar hammer syndromes are uncommon conditions characterised by digital ischemia of the hand as a result of repetitive trauma at level of the thenar and/or hypothenar eminence and damage to the radial and/or ulnar arteries, respectively. The symptoms are related to the mechanism of the trauma and a Raynaud's phenomenon can be predominant for a long time. The angiography is the “gold standard” imaging technique which allows to confirm the diagnosis. Therapeutic strategy depends on the type of the lesion and severity of symptoms and includes pharmacological (antithrombotic and thrombolytic drugs) and surgical treatments. The authors present a case of a 53-year-old man, carpenter by profession, with combined thenar and hypothenar hammer syndromes and Raynaud's phenomenon, successfully treated with a short course of intravenous infusion of iloprost.

Administering iloprost for severe Raynaud's phenomenon

T topic of this month’s Calculation Skills is iloprost, a synthetic analogue of prostacyclin, which is known to dilate pulmonary and arterial vascular beds. Iloprost has been used via a nebulizer to treat pulmonary hypertension and by intravenous (IV) infusion to treat other diseases where the constriction of blood vessels interferes with blood supply to the tissues, such as scleroderma and Raynaud’s phenomenon. This instalment looks at intravenous administration of iloprost in patients with severe Raynaud’s phenomenon. In the UK, the iloprost nebulizer solution is licensed as Ventavis (electronic Medicines Compendium, 2014). Iloprost injection is available as an unlicensed product in the UK but is licensed (Ilomedin) in other parts of the world (Bayer New Zealand Limited, 2012). Raynaud’s phenomenon is characterized by paroxysmal vasospasm followed by vasodilation of the peripheral arterioles, most commonly of the hands and feet (Tidy, 2013). The term ‘Raynaud’s phenomenon’ encompasses both Raynaud’s disease and Raynaud’s syndrome, although there is some overlap between them: ■ Primary Raynaud’s phenomenon (Raynaud’s disease) has no known cause. It occurs mostly in younger people (usually under the age of 30 years, although it can occur at any age) and is more common in women. It often has a genetic component— about a third of patients have a firstdegree relative affected ■ Secondary Raynaud’s phenomenon (Raynaud’s syndrome) is less common but has a known cause. It occurs mostly in people over the age of 30 years, but can occur at any age. It is linked to multiple causes including autoimmune disease; arterial and vasospastic disorders; haematological, endocrine and metabolic disorders; mechanical and environmental factors, such as vibration and smoking; malignant disease; infection; and some drugs, including betablockers and certain cytotoxics. Intravenous iloprost infusion can be used to treat primary and secondary Raynaud’s phenomenon. It reduces the frequency and severity of attacks and Alison Eggleton

AB0831 An audit of the use of iloprost (prostacyclin analogue) for raynaud’s phenomenon (RP) in the rheumatology department, arrowe park hospital, wirral

BackgroundRP is described as the vasospasm of arteries or arterioles, usually causing a triphasic colour change. To our knowledge there are no guidelines for prostacyclin use in RP to date....

Bleomycin-Induced Raynaud's Phenomenon After Single-Dose Exposure: Risk Factors and Treatment With Intravenous Iloprost Infusion

Bleomycin-Induced Raynaud's Phenomenon After Single-Dose Exposure: Risk Factors and Treatment With Intravenous Iloprost Infusion

Longterm Effects of Endothelin Receptor Antagonism on Microvascular Damage Evaluated by Nailfold Capillaroscopic Analysis in Systemic Sclerosis

Systemic sclerosis (SSc) is characterized by microvascular injury, fibrosis, and hypoxia of involved tissues. The vasoactive peptide endothelin-1 (ET-1) seems to be implicated in these events. Using nailfold videocapillaroscopy (NVC), we evaluated longterm effects of ET-1 antagonist treatment on nailfold microvascular damage in patients with SSc, over a 3-year followup period. Thirty patients with SSc (mean age 64 ± 5 yrs, mean disease duration 8 ± 1 yrs) were recruited during their programmed standard treatment protocols. At baseline (T0), 15 patients with SSc (mean age 63 ± 15 yrs, mean disease duration 7 ± 3 yrs), already receiving cyclic intravenous infusion of iloprost (5 continuous days, average 80 μg/day, every 3 mo), continued the treatment for a further 3 years (ILO group). The remaining 15 patients with SSc (mean age 68 ± 13 yrs, mean disease duration 8 ± 4 yrs), although they continued the same cyclic intravenous iloprost treatment as the previous group, also received bosentan 125 mg twice a day for 3 years (ILO+BOS group). Qualitative analysis (scleroderma patterns) and semiquantitative scoring of the microvascular damage were performed by validated routine NVC methods. During followup, a statistically significant increase of capillary number was observed in the ILO+BOS group (p < 0.02), with a significant and progressive increase of angiogenesis (p < 0.01). In contrast, the ILO group showed a statistically significant decrease of capillary number (p < 0.05). After 3 years the number of capillaries was significantly higher in the ILO+BOS group than in the ILO group (p < 0.05). The score for giant capillaries decreased significantly in both groups of patients with SSc (p < 0.05). In this open study, longterm treatment with ET-1 receptor antagonist in combination with iloprost was found to interfere with progression of nailfold microvascular damage in patients with SSc, as assessed by NVC over a 3-year followup period.

Abstract 16790: Positive Inotropic Effects of Acute Intravenous Iloprost in Rats with Chronic Pulmonary Arterial Hypertension

Introduction: Pulmonary arterial hypertension (PAH) is a syndrome of increased pulmonary vascular resistance that ultimately leads to right ventricular failure. Supportive management for decompensated RV function in chronic PAH is not very well understood and acute administration of prostacyclins is sometimes considered. While prior studies of inotropic effects of prostacyclins on models of acute pulmonary hypertension have yielded mixed results, evaluation of these effects under conditions of chronic PAH and RV dysfunction have not been reported using invasive hemodynamics. We sought to study the effects of an acute intravenous infusion of iloprost on right ventricular contractility in a rat model of chronic PAH. Methods: Ten Sprague-Dawley rats weighing 250-350g were treated with monocrotaline 60mg/kg IP. Six weeks later, baseline hemodynamic assessment was done using pressure-volume measurements using conductance catheterization, and these were repeated 10-15 minutes after IV infusion of iloprost (20 µg/kg ). RV contractility was assessed by the End-systolic pressure volume relationship (ESPVR), and Ees/Ea (RV/PA coupling) were obtained by transient decrease in preload (IVC occlusion). All values are reported as mean ± SEM. Paired and unpaired analysis was performed using Student's t-test. Results: Animals had evidence of PAH and RV hypertrophy. RV/LV+septum weight was 0.40 (±0.03). Right ventricular systolic pressure (RVSP) was 39.83 (±1.62) mmHg. Administration of iloprost demonstrated a significant increase in the slope of the ESPVR from 0.29 (±0.02) to 0.42 (±0.05) (p&lt;0.05), and ventricular-arterial coupling index Ees/Ea increased from 0.63 (±0.07) to 0.82 (±0.06) (p&lt;0.05). RV contractility index (max dP/dt normalized for instantaneous pressure) increased from 94.11/s to 114.5/s (p&lt;0.05) as did RV ejection fraction from 48.0% to 52.5% (p&lt;0.05). Pulmonary vascular resistance decreased from 0. 50 (±0.05) to 0.33 (±0.05) Wood units (p&lt;0.05). Conclusion: Our present study suggests a positive inotropic effect of iloprost (as evidenced by RV contractility index and ESPVR on remodeled right ventricles resulting from chronic PAH. The role of prostacyclins in the acute treatment algorithm of PAH merits further study.

Inhaled nitric oxide versus aerosolized iloprost for the treatment of pulmonary hypertension with left heart disease*

To determine the effects of inhaled nitric oxide (NO) and aerosolized iloprost on pulmonary hemodynamics and lung edema formation in a rat model of pulmonary hypertension due to congestive heart failure (CHF). Prospective, randomized, controlled study. Research laboratory. One hundred sixty male Sprague-Dawley rats. CHF was induced by supracoronary aortic banding whereas sham-operated rats served as controls. CHF rats or controls inhaled NO, aerosolized iloprost, or 0.9% NaCl for 3 minutes each. Additional CHF groups received intravenous infusions of iloprost, sodium nitroprusside, or 0.9% NaCl. For prolonged drug administration over 150 minutes, NO was inhaled continuously whereas aerosolized iloprost was administered for 3 minutes each at 45-minute intervals. Dose-response relations in rats with CHF showed a maximal pulmonary-selective reduction in blood pressure at 20 ppm NO and 2.5 microg/mL aerosolized iloprost, with iloprost therapy resulting in a greater decrease in pulmonary arterial pressure (PAP). At these doses, both vasodilators decreased pulmonary vascular resistance and increased venous oxygen saturation (Svo2) in the absence of systemic hemodynamic effects. No pulmonary or systemic effects were detected in rats with CHF inhaling 0.9% NaCl or in control rats inhaling NO or iloprost. Intravenous infusion of iloprost or sodium nitroprusside not only reduced pulmonary but also systemic vascular resistance. During prolonged inhalation, NO caused a stable reduction in PAP, whereas PAP decreased even further during repetitive iloprost inhalations. After 150 minutes, iloprost-treated rats had a higher Svo2 and lesser edema as compared with animals with CHF inhaling NO or untreated rats with CHF, although differences in wet/dry weight ratio did not reach statistical significance (p < 0.06). Inhaled vasodilators may offer an effective, safe, and pulmonary-selective strategy for the treatment of pulmonary hypertension in left heart disease, and inhaled iloprost may be superior to NO in this condition.

Leg ulcer treatment

Venous ulcers continue to cause problems for patients and health care systems. These are painful and unpleasant for the patient and expensive for health care providers to treat. This brief review highlights effective methods of management. There is level 1 evidence of the efficacy of compression (bandaging or stockings) in healing ulcers as well as maintaining healing. Patients with superficial saphenous reflux, with or without perforating and deep vein incompetence, benefit from superficial venous surgery. This does not speed ulcer healing but is effective at preventing recurrence after healing with compression. Minimally invasive methods of managing incompetence of superficial saphenous trunks, including endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy are probably also effective in treating patients with venous leg ulcers. Perforating vein ligation is commonly combined with superficial venous surgery for leg ulcer patients, but no systematic data are available to define the role of this treatment. Some centers use deep vein reconstruction to restore competence to deep vein valves. Insufficient data have been published to allow any general recommendation to be made for this treatment. A limited number of drugs have efficacy in promoting leg ulcer healing. They may be used in combination with compression treatment in patients with ulcers refractory to other methods of management. No particular ulcer dressing has been shown to be effective in speeding ulcer healing.

Use of Microsurgery and Iloprost in the Infantile Arterial Injuries

To evaluate the use and advantage of microsurgical intervention and intravenous iloprost administration in delayed infantile artery injuries. Four patients were followed up and treated in our clinic between June 2003 and June 2006 for infantile artery injuries and distal ischemia. The average age of the 4 infants (3 girls, 1 boy) was 134.7+/-33.6 days. The reason for all of the artery injuries was iatrogenic. Tissue necrosis started in patches in 2 babies who were admitted at the 12(th) hour after ischemia (19(th) and 22(nd) hours), and therefore the artery was repaired by microsurgery. Iloprost infusion was also used in addition to the conservative treatments. The other 2 patients were assessed before the first 12 h after distal ischemia and were treated by iloprost without any surgical intervention. None of the patients lost any tissue or extremities during the 9 months (average) follow-up time. One of our patients died following the ventricular septal defect repair at the 9(th) month after a successful repair of artery. We believe that intravenous iloprost infusion is very effective in the treatment of distal ischemia when used in addition to the conservative treatment methods for artery injuries in infants.

A case of Raynaud's phenomenon in mixed connective tissue disease responding to rituximab therapy

SIR, We wish to report the first successful use of rituximab in Raynaud’s phenomenon associated with mixed connective tissue disease, with disappearance of associated anti-RNP antibodies. A 40-yr-old lady presented in 1997 with swelling of the small joints of her hands, Raynaud’s phenomenon and a restrictive lung defect on pulmonary function tests. She did not have features of other connective tissue diseases. She had a positive test for antibodies to ribonuclear protein (RNP) on two occasions and a diagnosis of mixed connective tissue disease was made. She remained stable on prednisolone 5–10 mg and hydroxycloroquine 200 mg bd until 2001. Raynaud’s phenomenon then worsened, requiring intravenous infusion of iloprost (titrated from 0.5 to 2 mcg/kg/min on three successive days) every 3 months. Later, bosentan (125 mg bd) and tadalafil (10 mg bd) were tried. A digital sympathectomy helped briefly, but 3-monthly iloprost infusion continued, with infection of a femoral line on two occasions.

Evidenzbasierte Therapie des Raynaud-Syndroms

Raynaud's syndrome has a prevalence of 3-5% in the general population. Despite its high frequency, the majority of available therapies have not been validated in randomized controlled trials. Effective therapies with a high level of evidence include the calcium channel blocker nifedipine. As analyzed by meta-analyses, nifedipine showed improvement of the peripheral circulation, as well as reduction of both the intensity and frequency of attacks in patients with primary and secondary Raynaud's syndrome as compared to placebo. Similar results in a metaanalysis were obtained for intravenous infusions of iloprost in patients with secondary Raynaud's phenomenon associated with systemic sclerosis. In addition, intravenous infusions of iloprost improved healing of fingertip ulcers in patients with systemic sclerosis. Therapies with significant effects in single randomized controlled trials include angiotensin II-receptor type 1 antagonists (losartan), the calcium channel blockers felodipine und amlodipine, serotonin-reuptake-inhibitors (fluoxetine) und phosphodiesterase-V-inhibitors (sildenafil, vardenafil). However, the results for these promising substances have to be confirmed in long-term trials with larger patient numbers.

Iloprost treatment in patients with Raynaud's phenomenon secondary to systemic sclerosis and the quality of life: a new therapeutic protocol

To evaluate the clinical efficacy and the effects on the quality of life of iloprost, a prostacyclin analogue, used according to a new protocol in patients with Raynaud's phenomenon secondary to systemic sclerosis. In this randomized study, we treated 30 patients with iloprost, given by intravenous infusion, at progressively increasing doses (from 0.5 to 2 ng/kg/min) over a period of 6 h each day for 10 days in two consecutive weeks, with repeated cycles at regular intervals of 3 months for 18 months. The results were compared with those obtained in 30 other patients who received the same drug but with different dosing schemes. The total average daily duration of the attacks, the average duration of a single attack and the average daily frequency of the attacks were reduced significantly in all treatment groups, but the comparison between the groups demonstrated significant differences between patients treated with the new protocol and the others at later times (12 and 18 months). The effects on the quality of life in the group treated with the new protocol, evaluated with the Short Form-36, demonstrated a marked improvement regarding both the scale relating to the physical aspect of the illness and, especially, the scale relating to the mental aspect. In patients with systemic sclerosis, cyclic intravenous iloprost infusion is efficacious in the treatment of Raynaud's phenomenon. The protocol that we used, compared with others, not only has favourable clinical effects but also leads to a marked improvement in the quality of life.

Comparison of acute hemodynamic effects of aerosolized and intravenous iloprost in secondary pulmonary hypertension in children with congenital heart disease

Both aerosolized and intravenous infusion of iloprost caused a significant decrease in mean pulmonary artery pressure and pulmonary vascular resistance. Although intravenous infusion caused a large decrease in mean systemic arterial pressure, this was only slightly affected by aerosolized iloprost. Aerosolized iloprost caused a significant decrease in the pulmonary-to-systemic vascular resistance ratio; however, intravenous infusion did not cause a prominent decrease in this ratio.

Juvenile bone-marrow oedema of the acetabulum treated by iloprost

The bone-marrow oedema syndrome is associated with local vascular disturbances and may be treated either conservatively or by core decompression after which recovery may take several weeks. We describe a 15-year-old girl with bone-marrow oedema of the left acetabulum which was confirmed by MRI. She presented with a four-week history of severe constant pain. Routine blood tests and plain radiographs were normal. She was treated with intravenous infusions of iloprost on five consecutive days (20 μg administered in 500 ml of sodium chloride). Iloprost causes vasodilatation with reduction of capillary permeability and it inhibits platelet aggregation. She had relief from pain at rest after three days of treatment and was completely free from symptoms after two weeks. MRI after six weeks showed almost complete resolution of the marrow oedema and was normal after four months. This is the first report of the pharmacological treatment of the bone-marrow oedema syndrome in children.

Sustained normalization of cerebral blood-flow after iloprost therapy in a patient with neuropsychiatric systemic lupus erythematosus

We report the case of a 30-year-old caucasian woman affected by SLE who developed neurological symptoms (prosopagnosia and visual-spatial agnosia) after nine years of disease. Brain MRI showed no abnormalities while a brain SPECT scan showed diffuse uptake defects and hypoperfusion areas in the right and left frontal-parietal regions. At that time the patient was on hydroxychloroquine (400 mg/day) and oral prednisolone (0.5 mg/kg/day) as maintenance therapy. One year later the patient showed worsening of Raynaud's phenomenon with digital dystrophic lesions and was therefore treated with an intravenous infusion of Iloprost (1.5 ng/kg/min per 6h/day for 10 days consecutively), while baseline treatment remained unchanged. One month later the patient showed a dramatic improvement in her cognitive function and subsequent SPECT scans showed the gradual disappearance of perfusion abnormalities. This first report of Iloprost treatment in CNS lupus suggests the potential therapeutic usefulness of this drug in patients with SLE and functional CNS involvement.

Effects of iloprost, a stable prostacyclin analog, on intestinal leukocyte adherence and microvascular blood flow in rat experimental endotoxemia.

To investigate the effects of iloprost, a stable prostacyclin analog, on leukocyte adherence in intestinal venules and intestinal microvascular blood flow in experimental endotoxemia. Prospective, randomized, controlled animal study. Experimental laboratory. Twenty-one male Wistar rats weighing 190 +/- 40 g. The rats were divided equally into three groups: the first was a control group; the second received endotoxin (20 mg/kg lipopolysaccharide from Escherichia coli O55:B5 intravenously); and the third received endotoxin and intravenous iloprost infusion (2 ng.kg-1.min-1). The distal small intestine of the animals was examined by using intravital fluorescence videomicroscopy 2 hrs after endotoxin challenge. Leukocytes were stained in vivo by means of rhodamine 6G. Intestinal microvascular blood flow was measured by laser Doppler flowmetry in the terminal ileum. Iloprost treatment significantly attenuated the count of adherent leukocytes in collecting venules (control, 61 +/- 10 n/mm2; lipopolysaccharide, 364 +/- 60 n/mm2; iloprost, 232 +/- 29 n/mm2; p <.05) and in postcapillary venules (control, 96 +/- 14 n/mm2; lipopolysaccharide, 470 +/- 21 n/mm2; iloprost 390 +/- 41 n/mm2; p <.05). Intestinal microvascular blood flow was decreased significantly in the lipopolysaccharide group (-49%), whereas iloprost-treated animals showed no significant difference compared with the control group. The study demonstrated that administration of iloprost attenuated leukocyte adherence in postcapillary and collecting intestinal venules and improved intestinal microvascular blood flow. Thus, iloprost treatment may impact endotoxin-induced intestinal injury.

Early protective effects of iloprost after experimental spinal cord ischemia in rabbits.

The potential role of Iloprost, a stable analogue of prostocyclin, in treating spinal cord ischemia was investigated in rabbits subjected to aortic occlusion for 15 minutes. Ten adult rabbits weighing 2-2.5 kg received an intravenous infusion of saline (SF) as a control group and 14 rabbits received an intravenous infusion of Iloprost, 25 microg/kg/h. Iloprost infusion was started immediately after clamping of the aorta and continued 60 minutes thereafter. Cortical somatosensorial evoked potentials (CSEP) were recorded during the pre-ischemic period as a baseline and post-ischemic readings were taken at 15, 30 and 60 minutes. There was no statistically significant difference between CSEP of the saline and Iloprost treated groups (p < 0.05). All animals were examined neurologically by using a modification of Tarlov scale and all subjects were then deeply anesthetized and their spinal cords were removed for light and electron microscopic examinations at 24 h after spinal cord ischemia. In order to obtain an accurate comparison of ultrastructural changes between saline treated and Iloprost treated groups, a grading scale was performed. The light microscopic and ultrastructural analysis of the Iloprost treated group revealed that there was moderate protection of the myelin and axons and edema was attenuated. Findings of this study suggest that Iloprost exerts a protective effect on spinal cord ischemia. However, further studies are needed to reveal possible mechanisms of protection provided by Iloprost.

Circumcision supplemented by dorsal penile nerve block with 0.75% ropivacaine: A complication

Background and Objectives: Dorsal penile nerve block is a common procedure and can provide effective analgesia after penile surgery. Ischemic complications are rare and generally result from trauma or inadvertent administration of vasoconstrictive solutions. Case Report: We describe a period of temporary ischemia of the glans penis occurring 40 minutes after dorsal penile nerve block with 0.75% ropivacaine. This was successfully treated with an intravenous infusion of iloprost (a PGI 2 analogue), and at 43 hours appearances were normal. Conclusion: Theoretical concerns over the vasoconstrictive properties of ropivacaine may be sufficient to avoid its use where the potential for ischemia to end organs is present. Reg Anesth Pain Med 2000;25:424-427.