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Adenosine-induced Transient Asystole for Intracranial Aneurysm Surgery: A Retrospective Review.
MedLine Citation:
PMID:  20706138     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Cerebral aneurysms are highly variable which may result in difficult surgical exposure for clip ligation in select cases. Secure clip placement is often not feasible without temporarily decompressing the aneurysm. This can be accomplished with temporary clip ligation of proximal vessels, or with deep hypothermic circulatory arrest on cardiopulmonary bypass, although these methods have their own inherent risks. Here we describe an alternate method of decompressing the aneurysm via adenosine-induced transient asystole.
METHODS: We examined the records of 27 patients who underwent craniotomy for cerebral aneurysm clipping in which adenosine was used to induce transient asystole to facilitate clip ligation. Duration of adenosine-induced bradycardia (heart rate <40) and hypotension (SBP<60) recorded on the electronic anesthesia record and outcome data including incidence of successful clipping, intraoperative and postoperative complications, and mortality were recorded.
RESULTS: Satisfactory aneurysm decompression was achieved in all cases, and all aneurysms were clipped successfully. The median dose of intravenous adenosine resulting in bradycardia greater than 30 seconds was 30 mg. The median dose of adenosine resulting in hypotension greater than 30 seconds was 15 mg, and greater than 60 seconds was 30 mg. One case of prolonged hypotension after rapid redosing of adenosine required brief closed chest compressions before circulation was spontaneously restored. No other adverse events were observed.
CONCLUSIONS: Adenosine cardiac arrest is a relatively novel method for decompression of intracranial aneurysms to facilitate clip application. With appropriate safety precautions, it is a reasonable alternative method when temporary clipping of proximal vessels is not desirable or not possible.
Authors:
Nicole R Guinn; David L McDonagh; Cecil O Borel; David R Wright; Ali R Zomorodi; Ciaran J Powers; David S Warner; Arthur M Lam; Gavin W Britz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgical anesthesiology     Volume:  23     ISSN:  1537-1921     ISO Abbreviation:  J Neurosurg Anesthesiol     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8910749     Medline TA:  J Neurosurg Anesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  35-40     Citation Subset:  IM    
Affiliation:
*Department of Anesthesiology †Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC ‡Department of Neurosurgery, Ohio State University, Columbus, OH §Swedish Neuroscience Institute, Seattle, WA.
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