**5. Conclusion**

The problem of grafts spasm has become more obvious with the increasing use of new arterial grafts. Arterial spasm is a multifactor phenomenon modulated by different mechanism, such as drugs, temperature, endogenous catecholamine, and mechanical stimuli (surgical trauma), which is the most common cause. Surgical trauma can usually be minimized by harvesting the artery as a pedicle rather than skeletonizing it by careful surgical technique.

Antispastic management is an important part of technical considerations during CABG surgery. There is extensive evidence that the use of appropriate vasodilators during CABG surgery can facilitate the operative procedure as well as improve graft flow and reduce structural damage to the graft conduit. Spasm of arterial graft conduits is best managed by prevention rather than treatment after it has occurred. There are many dilators of arterial grafts that vary in potency, rapidity of onset, and duration of action as shown in organ bath studies. Using these findings to make a rational choice of type of dilator and optimal concentration for clinical use requires an understanding of the reactivity of that particular type of graft to vasoconstrictor and vasodilator agents. In addition, clinical choice of grafts must be based on consideration of many additional factors, including the systemic effects of the agent if it enters the circulation, the effect of the agent and its vehicle on the endothelium, convenience of preparation, and cost.
